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Bacteriology in a Nutshell 





Primer for Junior Nurses 


COMPILED AND ARRANGED BY 

MARY E. REID, 

GRADUATE NURSE, 


Late Superintendent Thomas Hospital Training School for 
Nurses, Charleston, W. Va.: Assistant Instructor 
in General Nursing Woman’s Branch of 
the German Hospital, Cincinnati. 


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DEDICATION : 

To Charlotte A. Aikens, Superintendent of Iowa Methodist Hospi¬ 
tal, Des Moines, Iowa, General Director of the “Graduate Nurses 
Hospital Extension Course,” and Associate Editor The National 
Hospital Record, to whose suggestion this booklet owes its origin; 
and to my dear friend and old Superintendent, Sister Emilie Koch, 
of the German Hospital, Cincinnati, Ohio, “Bacteriology in a 
Nutshell” is most affectionately dedicated. 


CINCINNATI, OHIO. 
JULY, 1904. 






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LIBRARY of OON3SESS 
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FEB 13 1905 

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COPY B. 


COPYRIGHT 1904, 
BY MARY E. REID. 


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PUBLISHED FOR THE AUTHOR BY 
THE NATIONAL HOSPITAL RECORD PUBLISHING CO., 
DETROIT, MICH. 








CONTENTS. 


Chapter I.— Brief History of Bacteriology. 

Earliest days.—Perfection of the single lens.— 
The “Dutch Microscopist.”—His discoveries.— 
The compound microscope.—First account of the 
germ theory of disease.—A problem of ancient 
bacteriology.—Men who have made valuable con¬ 
tributions to the science.—Their discoveries. .9-19 

Chapter II.—The Relation of Bacteria to Disease. 

BACTERIA IN PROCESSES OF NATURE. 

Mysteries revealed by the microscope.—Cell 
formation.—The organs and systems of the 
body.—Health dependence.—Cell functions.— 
Cell derangement.—The term bacteria.—Bacteria 
as friends. Bacteria as enemies.—The first use 
of the term bacteria.—Relative size of sapro¬ 
phytic and parasitic families.20-26 

Chapter III.— Description of the Most Important 
Bacteria.—Methods of Multiplication, etc. 

Morphology.—Spore-forming bacteria. Non¬ 
spore-forming bacteria.—Development.—Multipli¬ 
cation.—Dimensions.—Coloring bacteria.—Pha¬ 
gocytes.—Phagocytosis.—Resistive power of 
spores.—Parent bacillus after spore formation; 
its life or death.27-33 

Chapter IV.—Bacterial Invasion. How Bacteria 
Gain an Entrance to the System. 

Parke’s list of communicable diseases.—Period of 
incubation.—Invasion.—Channels of Entrance.— 
Development of symptoms.—Ho.w infection is 
thrown off.—Sources whereby bacteria die within 
the body.—Immunity, natural, acquired, artificial. 
—Antitoxins—their preparation and uses.— 
Koch’s Circuit .34-41 

Chapter V.—Common Communicable Diseases. 

Why the term communicable has taken the place 
of the terms contagious and infectious.—The 
bacteria found present in some of the diseases 





mentioned.—Transmission of diseases.—Seat of 
invasion or attack.—Effects of invasion.—Multi¬ 
plication or extermination of germs.—Fresh air 
and ventilation in communicable diseases.—Bac¬ 
teria in water, milk, and so forth.—Duties of the 
nurse in communicable diseases.42-67 

Chapter VI.— Bacteria in Surgery. — Sepsis. — Asep¬ 
sis.—Antisepsis. 

Bacteria most frequently found in surgery ; cases 
in which they occur.—Sepsis. Asepsis. Antisepsis. 
Causes of sepsis.—Why sepsis should not occur 
in the present age.—Why surgeons and nurses 
dread sepsis.—The debt the world owes to Lord 
Lister.—The vigilant nurse.—Sterilization.—Dis¬ 
infection.—Antiseptics. — Germicides. — Deodor¬ 
ants.—Heat as a germicide.—Intermittent steril¬ 
ization.—Aseptic surgery.—Hand disinfection.— 
Disinfection of instruments, rooms, furniture, 
beds, bedding, etc..68-82 

Chapter VII.— Solutions, Their Preparation and 
Uses.—Fumigation. 

Some of the drugs in common use for the prepar¬ 
ation of solutions, how prepared, how used.— 
Normal salt solution, when and how used.— 
Sterile water.—Filtered water.—Distilled water.— 
Alcohol. — Ether. — Sulphur fumigation. — For¬ 
maldehyde.—Formalin.—“Hospital Formulary” 

giving number of grains used in preparation of 
solutions of various strength.—A common rule 
for the preparation of solutions from drugs in 
liquid form where absolute accuracy is not re¬ 
quired.83-95 

Chapter VIII.— Hygiene for ISIurses. 

The result of neglected hygienic laws.—Civiliza¬ 
tion, fashion, and hygiene.—Social restrictions no 
longer a menace to hygienic laws.—Out of door 
recreation.—Average length of days of the con¬ 
scientious nurse.—How this period may be pro¬ 
longed.—The successful nurse.—Her duty toward 
her neighbor.—Her duty toward herself.—Muscu¬ 
lar exercise.—Hygienic dress.—Uniform should 
not be worn on the street. The reason \yhy.— 
Obedience to Nature’s calls.—Diet.—Water sup¬ 
ply. Sunshine.—Fresh air.—Rest.—Sleep.—The 
nurse with “a Southern exposure”.96-108 






BACTERIOLOGY IN A NUTSHELL. 


INTRODUCTORY. 

In compiling this small primer of bacteriology 
for junior nurses, the work along bacteri¬ 
ological lines prepared as one of the mem¬ 
bers of the class of students of “The Grad¬ 
uate Nurses’ Hospital Extension Course,” in 
October, 1903 , has been used as a basis. 
Nothing new in the way of theory has 
been attempted. Much rather would the writer 
join the ranks of her sister nurses who so bravely 
have enlisted to help the noble army of physicians 
and surgeons fight a victorious warfare against 
that branch of the bacteria family called “disease 
germs.” Most gladly would we all as nurses see 
these tiny foes to health destroyed forever. 

Superintendents of training schools have 
realized for some years that a few easily com¬ 
prehended lessons on bacteriology for junior 
nurses are necessary. The sole aim of “Bacteri¬ 
ology in a Nutshell” is to present to young 
nurses just starting out in the study of the 
germ theory of disease some of its principal 
teachings as briefly and as simply as possible. 
If the contents of this booklet have been made 
sufficiently clear to be easily grasped by those for 
whose benefit it is intended, and if it serves as 
an incentive to further study and research into 
this most interesting and useful branch of science, 
5 


the result will be more than gratifying to the 
writer and of lasting benefit to student nurses. 

Not only has much assistance been obtained 
from reviewing work done for the “Graduate 
Nurses’ Hospital Extension Course,” but also 
from a review of the older work of hospital train¬ 
ing school days and notes of lectures of Dr. E. 
Gustave Zinke, Dr. Magnus A. Tate and Dr. 
James W. Rowe, particularly lectures with re¬ 
gard to Sepsis, Asepsis, Antisepsis, Infection, 
Disinfection, Sterilization, etc. In addition to 
these helps, my own experience of recent years 
as a teacher in training schools has proven of 
material benefit. 

My thanks are especially due to Dr. James W. 
Rowe for valuable information with regard to 
the discoverers of bacteria, given to me since be¬ 
ginning the preparation of the primer, and also 
for helpful suggestions during the work of proof 
reading; to Miss Aikens, of the Iowa Methodist 
Hospital, for a kindly review of the manuscript 
in the National Hospital Record; to Miss Susie 
L. Wanzer, one of the old pupils of the Thomas 
Hospital Training School for Nurses, Charleston, 
W. Va., who so efficiently assisted in preparing 
the manuscript for publication, and who also 
made for me the drawings for cuts representing 
the forms of bacteria mentioned in the text. 

Mary E. Reid. 

Cincinnati, O., July, 1904 . 


• 6 















































































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MODIFIED OATH. 


The principles set forth in the following “modified 
oath,” which the nurses of the Brooks Memorial Hos¬ 
pital, Dunkirk, N. Y., are required to take at their 
graduating exercises, deserve a place opposite the 
initial page in every text-book written for nurses: 

"L solemnly promise and swear that in the prac¬ 
tice of my profession I will always be loyal to the 
patients entrusted to my care and to the physicians 
under whom I shall serve. That I will not make 
use of nor recommend any quack or secret nostrum. 
That 1 will be just and generous to members ot 
my profession, aiding them when they shall need 
aid and I can do so without detriment to myself 
or to my patient. That I will lead my life and 
practice my profession in uprightness and honor. 
That I will not lend my aid to any criminal or ille¬ 
gal practice whatever. That into whatever house 
I shall enter it shall be for the good of the sick to 
the utmost of my power. That whatever I shall 
see or hear of the lives of men and women, whether 
they be my patients or members of their house¬ 
holds, that will I hold inviolably secret and that I 
will continue to observe and to study and will strive 
in every way for the improvement of my profession; 
not regarding it as a means of livelihood alone, but 
as an honorable and upright calling.” 

To be loyal, to be honorable, to be just, to be gen¬ 
erous, to be pure, to be upright, to be trustworthy and 
“not a meddler in other men’s matters,” to be ob¬ 
servant, to be tactful, to be studious, all these are prin¬ 
ciples which, if they do not already possess them, 
should be instilled into the minds of all young women 
from the day they enter the training school until they 
leave it. All are links of grave import in the chain of 
“qualifications of a good nurse” as well as stepping- 
stones toward becoming “a perfect woman nobly 
planned.” 


8 


Bacteriology in a Nutshell. 


CHAPTER I. 

BRIEF HISTORY OF BACTERIOLOGY. 

Bacteriology is that branch of science which 
teaches us the evils of disease producing micro¬ 
organisms, and the benefits derived by the ani¬ 
mal world from another class which are antag¬ 
onistic to disease. 

The history of bacteriology can be traced 
back to the seventeenth century. Some au¬ 
thorities, indeed, tell us that at as early 
a date as the time of Caesar there lived a Roman 
author, Varro by name, who wrote of very tiny 
living “creatures” which were invisible to the 
naked eye, and yet they by some means gained 
an entrance into the system and “caused diseases 
difficult to treat.” Almost two thousand years roll 
by before we learn of the germ theory of disease 
being again touched upon, then, in the eighteenth 
century, it is advocated by Plenciz, of Vienna. 

In the year 1675 we are told that Antonius 
Von Leeuwenhoek, of Holland,* proclaimed to 
the world the perfection of his single lens by 
means of which he had brought to light “living, 
moving animalcules” in rainwater. So very tiny 

*Leeuwenhoek was born in Delft. Netherlands, ir 
1632; died in 1723. 


Definition. 


Earliest 

Mention. 


Perfection 

of 

Single Lens. 


9 




Leeuwenhoek’s 

Announcement. 


Theory 

of 

Plenciz. 


BACTERIOLOGY IN A NUTSHELL. 

were these objects that millions of them were 
found to exist in a single drop. 

The researches of Leeuwenhoek were contin¬ 
ued and in 1683 the world received another an¬ 
nouncement—the discovery under the compound 
microscope of a special form of bacteria in the 
scrapings of teeth and in saliva. This scientist 
presented the results of his work of research to 
the * Royal Society of London, England; suitable 
engravings accompanied the gift. We are not 
told whether or not Leeuwenhoek in any way 
connected the germs he discovered with disease 
causation; the supposition of authorities is that 
he did not. 

No attempt was made to classify, separate or 
identify the germs discovered by Leeuwenhoek, 
although many noted scientists of that century 
believed them, to be the cause of certain changes 
in the tissues of the human structure. It was not 
until the year 1762 that Antonius Plenciz, a phy¬ 
sician of Vienna, began ascribing to the micro¬ 
organisms discovered by Leeuwenhoek the power 
to produce the so-called infectious diseases. 

The theories advanced by Plenciz were these: 

I . —That the material which caused the infec¬ 
tion was a living substance; 

II. —That this living substance multiplied with¬ 
in the system, and that it could be thrown off by 
individuals and carried by the air to others; 

III. —That each separate infectious disease was 
brought into existence by a special germ which 
could cause no other disease; contending, in order 
to uphold his belief, that as only one kind of 

*Leeuwenhoek was chosen Fellow of the Royal So¬ 
ciety of London in 1685. 

IQ 



BRIEF HISTORY OF BACTERIOLOGY. 


grain can grow from one kind of seed, so also 
only one disease can be produced by one form of 
germ or micro-organism. 

The theory that disease germs were living 
things capable of growth and reproduction did 
not, at this time, gain favorable consideration, 
and it is not again advanced until almost sixty 
years have elapsed. In the year 1821 , * *Henle, an 
anatomist and scientist of Germany, again gave 
expression to the conviction of the truthfulness 
of the theory, but only to be met with the oppo¬ 
sition which defeated Plenciz. Henle, however, 
is said to have successfully met and overcome all 
the objections of his opponents, and shortly after 
this time the relation of micro-organisms to dis¬ 
ease was scientifically proven although many still 
remained sceptical. 

One point over which there was a great deal 
of discussion during the century and a half be¬ 
tween the discoveries of Leeuwenhoek and the 
acceptance of the theories of Plenciz through the 
demonstrations of Henle, was the origin of these 
germs. “Do they generate spontaneously or are 
they the descendants of pre-existing creatures of 
the same kind ?” *Karl H. Schulze, also of Ger¬ 
many, was the first to throw any light on this 
rather mystifying question. In 1836 he demon¬ 
strated the fact that “if the air which gained 
access to the material which was being experi¬ 
mented upon could be. made to pass through 

*F. Gustav Henle, born at Furth, Bavaria, 1798; 
died at Gottingen, 1885 . Was professor at Zurich, 
1824; Heidelburg, 1844, and at Gottingen, 1852. 

*Karl Heinrich Schulze, physician and anatomist 
born at Ault, Ruppin, in 179$. Professor at Berlin in 

1833. 


Plenciz’s 

Theory 

Accepted. 


Theory of 
Schulze. 


11 



BACTERIOLOGY IN A NUTSHELL, 


Proclamation 

of 

Semmelweis. 


strong acid or alkaline solutions decomposition 
would not take place.” Other scientists began to 
work along the same lines and obtained similar 
results. Their experiments, for the most part, 
were made upon wounds and their infections. 
They made no attempt to reproduce the infectious 
diseases by inoculation, which is the method used 
in our day. Numbers of scientific men of that 
period believed the presence of micro-organisms 
in the blood and tissues of individuals to be a 
normal condition. Others urged that the micro¬ 
organisms found in diseased conditions were the 
result of the disease and not its cause. 

A number of years passed before the work of 
discovering a special germ for each infectious 
disease made much progress. 

In 1847 Ignatius P. Semmelweis, a young 
Hungarian pursuing his studies in Vienna, pro¬ 
claimed to the world one of the greatest discov¬ 
eries along bacteriological lines, namely, that 
puerperal sepsis is the result of the invasion of 
the puerperal genital tract by specific micro-or¬ 
ganisms and from that year a new era in obstet¬ 
rical practice is dated. (There was much scep¬ 
ticism with regard to the theory of Semmelweis 
and he is said to have died in an insane asylum 
his malady the result of worry over unfriendlv 
criticism.) In 1849 the germ which causes 
anthrax was discovered by Pollender, of Ger¬ 
many, but it was not until the year 1863 that 
*Casimir Joseph Devaine, a Frenchman, by the 
process of inoculation proved that Pollender’s 
germ really produced anthrax. 

*Casimir Joseph Devaine, born at St. Armand-les- 
Eaux, France, in 1812; died in 1882. 

12 



BRIEF HISTORY OF BACTERIOLOGY. 

In 1862 *Louis Pasteur, of France, the fame of 
whose work at “Pasteur Institute,” Paris, is 
world wide, first began his experiments to prove 
that living organisms are in the air we breathe, 
in the food we eat, upon the clothing we wear, 
in the dust we tread beneath our feet, and that 
they may be found any place where dust settles. 
It had long been contended that the processes of 
fermentation and putrefaction were purely chem¬ 
ical processes and not the work of micro-organ¬ 
isms. It was proven also through the experi¬ 
ments of Pasteur that the reproduction of bac¬ 
teria takes place by processes similar to those 
which cause the reproduction of larger vegetable 
or plant life and not by spontaneous generation. 
Many other important discoveries are credited to 
the experiments of Pasteur. In fact, some scien¬ 
tific men of the present day go so far as to say 
that the real history of bacteriology dates no 
further back than to the experiments and discov¬ 
eries of Pasteur; that while it was not he who 
first discovered the existence of germ life, nor 
who first studied bacteria, nor who first suggested 
their connection with fermentative processes and 
with diseases, yet it is to his experiments we owe 
the placing of bacteriological study upon a firm 
basis, and that all the history of micro-organisms 
which antedates the experiments and discoveries 
of Pasteur is merely theoretical, more likely to be 
erroneous than otherwise. 

In 1872 Klebs began to teach that general 
sepsis is caused by bacteria invading the blood. 
Klebs is of German birth; he was born in 

♦Pasteur was born at Dole, Jura, France, in 1822; 
died in 1895. 


Pasteur’s 

Experiments. 


Errors 
Lessened by 
Pasteur. 


13 



BACTERIOLOGY IN A NUTSHELL. 


Dawn of 
Antisepsis. 


Later 

Discoveries. 


Koenigsberg; he was educated at Berlin, and 
later in life (1882-92) was professor at Zurich. 

In 1873 the micro-organism of relapsing fever 
was discovered. To Obermeier, of Germany, be¬ 
longs the credit for this discovery. 

By 1875 th e germ theory of disease was pretty 
generally accepted, at least by the scientific world. 
In that year Lord Lister, an English surgeon, 
who later (1877) was professor in King’s Col¬ 
lege, London, began the use of antiseptics 
in surgery. He based his experiments upon 
the discoveries of Pasteur. Carbolic acid 
solution was the first substance used bv Lister 
in his surgical operations, and thus was 
ushered in the era of antiseptic surgery. Less 
than thirty years have passed, and yet to what 
gigantic proportions has grown the use of sub¬ 
stances to either destroy germs or to prevent their 
doing mischief by stopping their growth! Car¬ 
bolic acid solutions still remain in common use. 

The bacillus of leprosy* was discovered by a 
German scientist, Hanson, in 1879, an d in the 
same year the micro-coccus of gonorrhoea by 
Neisser. (Neisser is also of German birth, prob¬ 
ably located at Munich at this time.) 

The bacillus typhosus, the germ of typhoid 
fever, was discovered by Eberth and Koch, of 
Germany, in 1880. 

And in that year (1880} came also the discov¬ 
ery of the germ of pneumonia. Some writers 

*In July, 1904, Rost, of the medical staff in India, 
reported that he had succeeded in cultivating the 
bacillus of leprosy and from the cultures had made 
a substance he called “leprolin,” which, when injected 
into the tissues of lepers, had a marked beneficial 
effect. 


14 



BRIEF HISTORY OF BACTERIOLOGY. 


give the credit (or discredit) for causing this 
disease to the micro-organism observed by Gen¬ 
eral Sternberg* * of the United States Army; 
others to the diplococcus lanceolatus, discovered 
by *Fr3enkel of Berlin, who was professor at 
Halle. Recent investigation has shown that the 
diplococcus discovered by Fraenkel is probably 
the sole cause of genuine acute, lobar pneumonia, 
although other germs, one of which is the 
“pneumo-bacillus of Friedlander,” are said to be 
sometimes found associated with this form of the 
disease. Several germs are believed to be capable 
of causing broncho-pneumonia. 

In 1882 the name of Robert Koch* sprang into 
fame when he made the greatest of his many dis¬ 
coveries—the germ which is the c^use of all 
forms of tuberculosis. This discovery is not only 
to be considered the greatest of Koch's discover¬ 
ies, but one of the greatest discoveries of the age, 
as to tuberculosis, in one or another of its forms, 
is due at least one-sixth of all the deaths which 
occur yearly in the human family. Had the rem¬ 
edy for this disease, prepared by Koch, proven a 
success, he would have immortalized his name in 
very deed. 

In 1884 Koch made another discovery, namely, 
the comma bacillus of cholera; so called because 
of its peculiar shape. (Pasteur discovered the 

* Authorities assert that the germ observed by Stern¬ 
berg and the diplococcus lanceolatus are probably iden¬ 
tical. Fraenkel associated the germ with pneumonia 
causation; Sternberg apparently did not. 

*Koch, born at Klausthal, Germany, in 1843. Led 
the German expedition which in 1883 went to Egypt 
and India to investigate cholera. In 1890 announced 
a cure for tuberculosis, the power of which experience 
did not demonstrate. 


Koch’s 

Discoveries. 


15 



BACTERIOLOGY IN A NUTSHELL. 


Progress 
of Other 
Scientists. 


germ of chicken cholera in 1880.) In 1884, also, 
the germ of diphtheria, called the bacillus diph¬ 
theria^ was discovered by Loeffler, and the bacill¬ 
us of tetanus, called the bacillus tetani, by Ni- 
colaier. 

The germ which causes “la grippe” was dis¬ 
covered in 1892 by Pfeiffer.^ Loeffler, Nicolaier, 
Pfeiffer, are all of German nationality. (Leud- 
wig Pfeiffer, born at Eisenach in 1842, lives at 
Weimar.) 

In 1894 came the discovery of the germ of the 
Eastern bubonic plague by Yersin, a Japanese. 

In 1897. the discovery of the bacillus of yellow 
fever was reported by Sanarelli, a Spaniard. 
This germ was not accepted because it failed to 
comply with certain requisite scientific tests. 
(Koch’s circuit,, spoken- of in chapter IV, was 
not proven.) The same is said of the germ 
found in carcinomatous specimens, and of the 
germ of small-pox reported by T)r. William T, 
Councilman of Harvard College, in the spring oi 
1904. Other discoveries are frequently reported. 
Syphilis is believed to be due to a micro-organ¬ 
ism which as yet remains undiscovered, although 
with other germs it is still being carefully sought 
after. 

SUMMARY OF CHAPTER I. 

The earliest days of bacteriology said to be 
traceable to the time of Caesar, in whose day a 
Roman writer hinted at the invasion of the human 
structure by “creatures” invisible to the naked 
eye and of their power to produce diseases. 

The perfection of the single lens. Nationality 
of die perfector. Discoveries of this scientist 
during the seventeenth century under the single 
16 


Summary. 


lens and by means of the compound microscope. 
The presentation of the results of his researches 
together with appropriate engravings to the 
Royal Society of London, England, of which so¬ 
ciety he^was afterward Fellow. 

Power to produce the so-called infectious dis¬ 
eases ascribed to micro-organisms by a scientist 
of Vienna. Theories advanced by this scientist. 
Non-acceptance of his theories: 

The germ theory of disease again advanced 
about sixty years later and its successful demon¬ 
stration. 

A short account of one of the subjects which 
caused much discussion during the century and a 
half between the discoveries of the Hollander and 
the acceptance of the theory of the scientist of 
Vienna. 

The man who first threw light upon the mys¬ 
tery surrounding this vexed question and the 
manner in which he carried on his experiments. 
Work and its results along the same lines by 
other scientific men of that period. 

Errors o£ some of the early students of bac¬ 
teriology. 

Slow progress in discovering a special germ for 
each infectious disease. 

Men who are considered to have made the most 
valuable contributions to bacteriology and their 
discoveries. 




17 


BACTERIOLOGY IN A NUTSHELL. 


QUESTIONS FOR REVIEW. 

I. —Who perfected the “single lens’’ and what 
were the first discoveries made by its perfector? 
In what year did he announce his discoveries? 
Are these the earliest discoveries of which we 
have any account ? 

II. —In what year were later discoveries an¬ 
nounced by this scientist? How were these dis¬ 
coveries made? To whom were the results of 
his researches presented? 

III. —What attempts were made to classify, 
separate and identify the germs discovered, and 
were they believed to be in any way connected 
with pathological changes in any particular part 
of the body ? 

IV. —Who was the first physician to ascribe to 
micro-organisms the power to produce the so- 
called infectious diseases? In what year was 
the announcement made? Was the theory ac¬ 
cepted ? 

V. —Who is said to have been the first to suc¬ 
cessfully demonstrate that the germs discovered 
in the seventeenth century could produce dis¬ 
eases ? 

VI. —Describe in detail one of the chief points 
of discussion during the years that elapsed be¬ 
tween the discoveries mentioned and their ac¬ 
ceptance as disease germs. Tell of the man who 
first threw a gleam of light on the vexed question, 
of the means used, of others who followed the 
same method of research, the results gained. 

VII. —Mention some of the errors of early stu¬ 
dents of bacteriology with regard to the germ 
theory of disease. To whom do some bacteriol- 

18 



REVIEW. 


ogists ascribe most credit for the firm basis of 
this theory in the present day? 

VIII. —By whom and in what year were anti¬ 
septics first used? In what class of cases were 
they used? What was the first substance used? 
Is it still in use and is it now considered a val¬ 
uable antiseptic? 

IX. —By whom and in what year was it first 
taught that bacterial invasion is the cause of 
puerperal sepsis? What became of this scientist? 
Who first taught the theory of general sepsis ? 

X. —By whom was the germ of typhoid fever 
discovered? In what year was the discovery 
made? Mention other discoveries made by one 
of these men? Which is considered to be the 
most important of his discoveries and why ? 

XI. —Name some of the important discoveries 
made during later years and their discoverers. 

XII. —Mention some diseases now considered 
to be caused by bacteria and explain why the 
germs discovered in one or two instances have 
not been accepted as the originators of the trouble. 



19 


CHAPTER II. 



THE RELATION OF BACTERIA TO DISEASE-BACTERIA 

IN PROCESSES OF NATURE. 

Revelations 
of the 
Microscope. 

Mysteries concerning the origin of numerous 
diseases, which must otherwise have remained 
mysteries forever, have been made more or less 
clear since the perfecting of the microscope. 
Prior to the revelations made by the use of this 
instrument, very little was positively known con¬ 
cerning the formation of the various elements of 
which the machinery of the human structure is 
made up and by which it is kept in running 
order. Now scientists are able to trace the 

Cell 

Formation. 

human body back to the time when it 
was but a single cell, from this single 
cell to watch its growth and development 
into innumerable single cells, to see the single 
cells fold into layers, these in their turn 
to form the groups of cells out of which the 
various bones and muscles and nerves and tubes 

Organs and 
System. 

and tissues of the body are composed. These 
groups we call the organs and systems of the 
body. Each has its own work to perform, and 
each exists to a certain extent independently of 
the other. Yet all are so intimately related and 
connected in their efforts to maintain life and 
health that when disease comes to one group of 
cells composing a system, other groups compos¬ 
ing other systems suffer also. 

20 




BACTERIA AND DISEASE. 


The group of cells from which the muscular 
system is made up, by their united action, called 
into play by nerves, produce our movements. 
Another group of cells forms the liver, and har¬ 
monious action of this group is necessary in 
order that impurities be removed from the blood. 
Certain fluids which are essential to the welfare 
of the body are also manufactured by this 
group. The brain is composed of another group 
of cells of a different type; from these thought 
and intelligence emanate, and from still another 
group is composed the nerves which convey mes¬ 
sages to and fro between the brain and the outer 
world and so on. 

As nurses, then, let us grasp this thought that 
“disease is a derangement of the structures or 
functions of the body,” and in order that the 
human structure remain healthy, there must be 
harmonious action between separate types or 
groups of cells. If one group fails to work har¬ 
moniously, then comes a disturbance of the har¬ 
mony of the other groups, and because of this 
disturbance there comes disease. For example: 
If there is trouble in the nervous system then, 
too, we find the digestive system is affected, and 
vice versa. So we may go on through the other 
systems and find them all more or less dependent 
one upon another. 

The causes of disease are many and varied. 
One of the most serious causes, as revealed 
by scientific research, is the invasion of the dif¬ 
ferent organs and systems of the human structure 
by a species of bacteria; these it has been proven 
produce the so-called infectious diseases. So 
much has been said and written on “the relation 


Action of 
Various Cells. 


Brain and 
Nerve Cells. 


Definition of 
Disease. 


Bacteria a 
Cause of 
Disease. 


21 


BACTERIOLOGY IN A NUTSHELL. 


Bacteria 

Explained. 


Saprophytic 

Bacteria. 


Parasitic 
Bacteria 
Our Foes. 


Good 

Bacteria. 


of bacteria to disease” that many people fail to 
discriminate between the bacteria which are our 
friends and those which are our enemies. 

As pupils in the study of bacteriology we learn 
that the term bacteria is applied by scientists to 
the large group of minute vegetable micro-organ-^ 
isms, commonly called “germs” or “microbes.” 
This name was first given to them about the year 
1869, after *Hoffman had demonstrated that 
these tiny mysteries occupied a class by them¬ 
selves, quite distinct from yeast plants and 
moulds with which they had been confused in 
earlier days of bacteriological research. 

All forms of bacteria may be divided into two 
great classes in order to simplify for study. 
These two classes are called the saprophytes, and 
the parasites. The saprophytes, which are the 
friends of all animal life, are many times more 
numerous than the parasites. Parasites are en¬ 
emies to animal life; they are the so-called “dis¬ 
ease germs” or “microbes”; they exist only at 
the expense of other living bodies. They invade 
various parts of the living body and under fav¬ 
orable conditions they weaken and sometimes 
destroy the parts they invade. They take away 
from us substances on which our health is de¬ 
pendent, and deposit in their place that which 
poisons and frequently completely destroys. Be¬ 
cause of their power to produce pathological 
changes in animal bodies, parasitic bacteria are 
also called pathogenic bacteria. 

Saprophytic bacteria are not only our friends, 
but they are of such benefit to mankind that we 

*Hoffman was a German botanist. Born at Roe- 
delsheim, 1819; died at Giessen, 1891. 

22 



BACTERIA IN PROCESSES OF NATURE. 


could not live without them. They live upon 
dead organic matter, and by their activities de¬ 
composition, fermentation and putrefaction are 
produced. Nourishment necessary to the suste¬ 
nance of vegetable life is derived from carbonic 
acid gas, ammonia and water, which are all pro¬ 
duced by the action of saprophytic bacteria on 
dead animals and vegetables. Vegetable and 
plant life would cease to exist if the carbon and 
nitrogen to which they owe their growth and de¬ 
velopment could not be obtained from this source. 
Animal life is sustained by the oxygen thrown 
off by trees and plants and to a certain extent by 
the food obtained from the vegetable world; 
therefore, the work of the saprophytes is neces¬ 
sary to the existence of all forms of life. 

With regard to the work of saprophytes as our 
friends in the processes of Nature, let us look a 
little farther into this phase as explained to us 
by scientists. Let us see why it is that they play 
so important a part in these processes, and how 
it is that they arc so completely interwoven with 
the vital powers of nature, that life in all its 
forms would vanish from the earth should their 
activities cease. 

When as children we explored the woods and 
perched ourselves upon fallen tree trunks and 
saw them dropping into decay, how many of us 
now studying bacteria in regard to their connec¬ 
tion with our work as nurses ever associated the 
process of decay with the activities of germs? 
To-day we are taught that bacteria play an im¬ 
portant part in this process after the hard, woody 
substance of the tree has been softened and pre¬ 
pared for their work by moulds. Then, after the 
23 


Bacteria in 

Natural 

Processes. 


Decay of Trees 
and Plants. 


BACTERIOLOGY IN A NUTSHELL. 


Decay of 
Animals. 


Where 
Oxygen is 
Obtained. 


tree has been attacked by bacteria, it drops to 
pieces as a yellowish brown deposit, to mix with 
dead leaves and sink into the soil as a fertilizer 
to promote the growth of healthy plants and trees 
that inhabit the forest. 

The same thing happens in decay of dead 
plants and animals. In decomposition of animals 
saprophytes play a still more important part, as 
it is by their agency alone that the work on every 
part of such bodies is accomplished, and the prep¬ 
aration made for mixing with the soil and the 
atmosphere. Whatever of the decayed substance 
of tree and plant and animal is not of use as a 
fertilizer is disseminated in the form of gases to 
be taken up by the air. So plant and vegetable 
and animal life are renewed and sustained in a 
great measure by the fertilization of the soil by 
decomposition of dead plants and vegetables and 
animals, and by the gases they disseminate, none 
of which would come to pass without the activ¬ 
ities. of bacteria. 

We inhale from the atmosphere oxygen, which 
is absolutely necessary for the sustenance of ani¬ 
mal life, and which is thrown off for our use 
from growing plants and trees and other forms 
of vegetable life. We exhale carbonic acid gas, 
or “carbon dioxide,” which, together with the 
influences of the sun and the rain, is necessary 
for the growth and sustenance of trees and plants 
and vegetables. This is one way, among others, 
in which the animal kingdom is necessary to the 
vegetable kingdom and vice versa, the plant 
and vegetable world giving off oxygen for use of 
the animal world, and the animal world in its turn 
supplying the plant and vegetable world with 
24 


SUMMARY AND REVIEW. 


carbon dioxide in a ceaseless round. All other 
foods used to sustain animal and plant life are 
so arranged by the processes of Nature as to be 
used again and again in a continuous circle, first 
by plants and then by animals, and then over 
again by plants, the circle to endure so long as 
the sun shines and the rain falls to promote its 
continuance. Many of these processes require 
much thought in order to understand the intri¬ 
cate workings of Nature. Those who under¬ 
take the study in earnest find it of special inter¬ 
est. Not the least interesting phase is the way 
in which nitrogenous foods, so necessary to ani¬ 
mal life, take their place in the continuous circle, 
and how, through the assistance of bacteria they 
are prepared to return to take part in the main¬ 
tenance of plant and vegetable life. 

Bacteria which assist in the sprouting of seeds 
and in other processes of Nature in farm and 
garden, form an interesting study, also. 

SUMMARY OF CHAPTER II. 

Mysteries with regard to diseases revealed by 
the microscope. 

Cell formation and the formation of the or¬ 
gans and systems. 

Health of the various organs and systems of 
the body dependent one upon another. 

Functions of some of the groups of cells. 

Derangement of the structure and its functions 
the cause of diseases. 

Bacteria as friends and as enemies. 

Application of the term bacteria. 

Length of time the term has been in use and 
the scientist who first distinguished the group 
from yeasts and moulds. His nationality. 

25 


Nature in 
Food Supply. 



BACTERIOLOGY IN A NUTSHELL. 


Difference in size of the saprophytic and para¬ 
sitic families. 

What we understand by the term pathogenic 
bacteria. 

Saprophytic bacteria and the benefits derived 
from them by the animal and the vegetable king¬ 
doms. 


QUESTIONS FOR REVIEW.—CHAPTER II. 

I. —How has the perfecting of the microscope 
been of benefit to mankind in a special way ? 

II. —Give in detail some of the mysteries with 
regard to the human structure as revealed by the 
microscope since its perfection. 

III. —Are the different systems of the body 
in any sense independent systems? Give one 
reason why they are not entirely independent. 

IV. —Mention the functions of the groups 
of cells spoken of in this chapter. 

V. —Explain what you understand by the term 
“disease” and give the cause of one serious form 
of disease. 

VI. —Into how many classes may bacteria be 
divided in order to simplify for study? 

VII. —Define bacteria, pathogenic bacteria, sap¬ 
rophytic bacteria. 

VIII. —Prove that pathogenic bacteria are foes 
to health. 

IX. —In what way do saprophytes benefit man¬ 
kind ? 

X. —Explain what would happen to plant and 
vegetable and animal life if saprophytic bacteria 
should be destroyed or become inactive? Give 
reasons for your answer? 

26 



CHAPTER III. 


DESCRIPTION OF THE MOST IMPORTANT BACTERIA 
METHODS OF MULTIPLICATION, ETC. 


Morphology is that branch of science which 
treats of the classification of bacteria with regard 
to their shape, outline, structure and their methods" 
of grouping. Placed in broth, bouillon or other 
substance they are cultivated, and much useful 
information has been gained with regard to the 
habits, etc., of these tiny specimens of vegetable 
life. 

It has been found by studying them under 
the microscope, that all bacteria of any import¬ 
ance are either “sphere,” “rod,” or “spiral” 
shaped, and so they are divided into these three 
classes. 


• 

Spheres. 


cocci, or 


Rods. 


The spherical may be perfectly 
round like a ball or marble, or they 
may be oval or egg-like; many are 
imperfect in shape. The name given 
to all bacteria of this formation is 
“micrococci.” 

The rod-shaped may be long or 
short, square or round at the ends, 
thick or thin, but all bear the com¬ 
mon name of “bacilli.” The larg¬ 
est number of disease germs are 


of this class. 


Morphology 

Defined. 


Micro-cocci. 


Bacilli. 


27 




BACTERIOLOGY IN A NUTSHELL. 


Spirilla. 


Staphylococci. 

Streptococci. 

Diplococci. 

Tetrads. 

Sarcinae. 


Size of 
Bacteria. 



Spirals. 


The spiral-shaped are said some¬ 
what to resemble the twisted part 
of a corkscrew, and whether they 
have few or many curves, whether 
loosely or tightly twisted, the one 
name, “spirilla,” covers all of this 
variety. 

Modifications or subdivisions of the cocci have 
also been determined by watching their manner 
of forming into groups as seen in growing cul¬ 
tures. 

Staphylococci is the term used to describe those 
w r hich group in masses like grape-clusters. 


Streptococci, to describe those with method of 
grouping into chain-like sections. 

Other forms of the micrococci are found to 
group in pairs, and to describe these the term 
diplococci is used. 

Those which form into groups of four are 
called tetrads. 

Still another form is seen to make up groups 
of eight and sixteen, and to describe these we 
use the term sarcinae. 

There are two main subdivisions of the bacilli, 
namely: bacilli which are spore-forming, and 
bacilli which are non-spore-forming. By the 
term spores we mean seeds or eggs of the bacilli. 

All forms of bacteria are dependent upon cer¬ 
tain conditions for their development; these con¬ 
ditions are a certain temperature, proper soil, and 
in some instances air. 

Size of bacteria is a part of their description 
difficult to determine. So tiny are they that it is 
only under the highest power of the microscope 
that scientists are able to study them at all. One 

* 28 


MORPHOLOGY. 


of the largest of the bacilli is said to be about 
1-12,000 of an inch in length, and 1-50,000 of an 
inch in thickness. We are told that it would take 
six thousand billions of the average sized bacilli 
to weigh one grain, and that fifteen hundred of 
the largest bacilli if placed end to end would not 
reach across a small pin head. Some forms of 
bacteria move about quickly, others do not. 

Weigert* in the year 1877 discovered that 
micro-organisms could be colored by the use of 
aniline dyes, so as to be distinguished from the 
media in which they are cultivated. Up to that 
time great difficulties stood in the way of their 
successful study, because of their transparency 
as well as their minuteness. Since Weigert’s 
discovery that they can be colored, many of the 
peculiarities by which their varieties are deter¬ 
mined have been pointed out. 

We have said that one condition necessary to 
the growth and development of bacteria is proper 
soil. A perfectly healthy body with normal re¬ 
sistive power is not favorable soil for the devel¬ 
opment of disease germs. In such a body certain 
cells exist which are foes to these germs; they 
have the power either to absorb or destroy dis¬ 
ease-producing bacteria. These cells are called 
phagocytes and the process of destruction or 
absorption is known as phagocytosis. The name 
phagocytes (from the Gk. phago *T eat”) was 
given to these cells by the man who dis¬ 
covered their province, the scientist, *Elie 
Metschnikoff, a Russian, one of the most 

♦Professor Carl Weigert, anatomist at Frank¬ 
fort, Germany. 

♦Metschnikoff was born in the government of 
Kharkoff in 1845. Was professor at Odessa in 1870. 

29 


Weigert’s 

Discovery. 


Function of 
Phagocytes. 



BACTERIOLOGY IN A NUTSHELL. 


Fission. 


Bacilli 
Method of 
Multiplication. 


distinguished bacteriologists of the present 
day and who is carrying on his work at 
Pasteur Institute, Paris, France, as successor to 
Pasteur. While scientists differ as. to the method 
of warfare as carried on between the cells of the 
body, termed phagocytes, and the germs of dis¬ 
ease, all agree that the healthy body has the 
power to overcome and exterminate such foes by 
their means. 

The body which is not healthy, and in which 
normal resistive power is absent, on the other 
hand is not able successfully to fight disease- 
producing germs which invade it at one point or 
another, they overcome weakened resistive forces, 
increase and multiply within the body, and we 
become victims of the disease the special form of 
bacteria present produces. 

There are two methods of multiplication in 
the bacterial world—fission and spore formation. 

The method by which micro-cocci and spirilla 
multiply is termed fission; fission in common 
everyday language means simply division. They 
rapidly separate or divide into a number of sec¬ 
tions, each of which soon leaves the parent cell, 
and in turn divides into other sections or parts. 
This process of division and subdivision is kept 
up as long as the germs have proper soil to exist 
upon, and provided, also, the temperature, air and 
moisture are such as they require. 

Bacilli multiply in much the same way and 
under conditions similar to those required by the 
micro-cocci and spirilla. This is especially true 
of the bacilli which are non-spore-forming. 

30 


MORPHOLOGY. 


With regard to the spore-forming bacilli, when 
they can no longer obtain sufficient or proper 
food or surroundings, they shrivel or dry up and 
appear to be dead. They may keep up this sem 
blance for months, but let conditions once more 
become favorable for their development and we 
soon find they not only are not dead but are nol 
even sleeping, merely resting. Place them in 
suitable culture media, for instance, and imme¬ 
diately they begin to germinate and produce in¬ 
numerable micro-organisms of the same variety 
as those from which they sprang. They do not re¬ 
produce other spores at once, but never fail to re¬ 
produce that characteristic variety of bacillus 
which is spore-forming. 

There are certain changes which take place in 
the bacilli when the process of seed or spore de¬ 
velopment is about to begin. Spores, or seeds, 
are made up of tiny particles of the protoplasm or 
active, life-giving substance of which bacilli are 
composed. They form sometimes at one end of 
the rod, sometimes at the other end, and again 
they may form in the center of the rod. They at 
first appear to be just tiny spots, or dots in the 
protoplasm of the parent bacillus, but very soon 
they begin to divide off and are easily distin¬ 
guished under the microscope as tiny seeds ot 
eggs which scientists call “spores.” They rapidly 
increase in size and break through the framework 
of the bacillus, the non-essential part of which 
usually dies and the seeds or spores are left be¬ 
hind in a protecting cover or capsule. This cover 
or capsule is said to enable spores to resist in¬ 
fluences that would very quickly destroy other 
forms of bacteria. The power possessed by 
3i 


Spore 

Forming 

Bacilli. 


Spore 

Formation. 


BACTERIOLOGY IN A NUTSHELL. 


Resistive 
Power of 
Spores. 


spores to resist heat and drying is found to be 
almost incredible. Bacteriologists assert that 
some forms of spores live on after they have 
been exposed for a brief period to a temperature 
of 360° F. Other forms have been treated to a 
bath of boiling water for a longer period, and yet 
both have come through these processes alive and 
have again germinated. 

While the parent bacillus, as a rule, is sup¬ 
posed to die during spore formation, because the 
spores use up the protoplasm of the parent for 
their own sustenance, this is believed not to be 
true in every instance. The functions of the 
parent cell are said sometimes to go on in the 
usual way during the process of spore-formation, 
sufficient of its protoplasm being retained to sus¬ 
tain life and again to renew its activities after the 
spores have broken through its walls. 


SUMMARY OF CHAPTER III. 

Classification with regard to shape, outline, etc. 

Definitions of various names descriptive of bac¬ 
teria. 

Methods of grouping as seen in growing cul¬ 
tures. 

Terms used to designate methods of grouping. 

Bacteria which form spores and those which 
do not. 

Development of bacteria dependent upon cer¬ 
tain conditions. 

Why it is difficult to determine dimensions of 
bacteria. 

Discovery of Weigert. 

Power of phagocytes. 

32 




SUMMARY AND REVIEW. 

The discoverer of phagocytes. 

Why bacteria sometimes conquer the phago¬ 
cytes. 

Methods whereby bacteria multiply. 

Process of spore-formation. 

Wonderful resistive power of spores. 

Parent bacillus after the process of spore-for¬ 
mation. 

QUESTIONS FOR REVIEW ON CHAPTER HI. 

I. —Why is the study of morphology important, 
and how is it best facilitated? 

II. —Describe each of the three forms of bac¬ 
teria. Which of these is most common ? 

III. —Is the process of multiplication of bac¬ 
teria rapid? If so, in what manner and under 
what conditions are they propagated? 

IV. —Are pure blood and healthy tissue con¬ 
ducive to the development of the various kinds 
of bacteria? 

V. —Which method of antagonizing disease 
germs appeals to you—resistance by a vigorous 
healthy body, or their destruction by the use of 
powerful drugs? 

VI. —What is the meaning of spore-forming 
as applied to bacteria? 

VII. —Are all varieties of bacteria spore-form¬ 
ing? About what is the size of the largest known 
bacillus ? 

VIII. —In what manner do micro-cocci and 
spirilla multiply? Give term applied and its 
meaning. 

IX. —Are spores easily exterminated? What 
can you say of their peculiar resistive powers ? 

X. —Does the parent bacillus remain vigorous 
after propagating its kind ? 

33 





CHAPTER IV. 


DISEASES CAUSED BY BACTERIAL INVASION. HOW 
BACTERIA GAIN AN ENTRANCE TO THE SYSTEM. 


Parkes, in his “M.anual of Hygiene and Public 
Health,” gives the following table of diseases due 
to the invasion of the human structure by bac¬ 
teria. He divides these diseases into five classes, 
viz.: 

CLASS I. 

Smallpox, 

Scarlet Fever, 

Measles, 

Mumps. 

Chicken-pox, 

Whooping Cough, 

Influenza, 

Relapsing Fever, 

Diphtheria, 

Erysipelas, 

Typhus, 

_ Epidemic Pneumonia. 

CLASS II. 

Yellow Fever, 

Cholera, 

Enteric (Typhoid) Fever, 

Dysentery, 

Diarrhoea, 

CLASS III. 

Anthrax or Malignant Pustule, 

Foot and Mouth Disease, 

Leprosy, 

Glanders, 

Rabies, 

Vaccinia, 


34 




parke's list,' etc. 


Ophthalmia, 

Syphilis, 

Gonorrhoea, 

Tetanus. 

CLASS IV. 

Erysipelas, 

Septicaemia, 

Hospital Gangrene, 

Puerperal Fever. 

CLASS V. 

Tuberculosis, including Lupus and Scrofula. 


I. —Diseases placed in class one are designated 
as air-borne, or, in other words, diseases which 
may be carried and communicated by floating 
dust. 

II. —It is claimed that diseases placed in class 
two may be carried and communicated by floating 
dust or taken into the system in water. The “air 
or water borne” diseases, so-called. 

III. —Inoculation, as a rule, is the means of 

communication of diseases mentioned in class 
three. . v 

IV. —A surface lesion is said to be necessary 
for the communication of diseases in class four. 
When this lesion is present the disease is com¬ 
municable by direct inoculation or may be trans¬ 
mitted through the air. (By “lesion” we mean a 
wound, hurt, or other local alteration of tissue 
from a higher to a lower condition.) 

V. —In class five a surface lesion is not neces¬ 
sary and the disease is communicable either by 
direct inoculation or through the air. 

35 



BACTERIOLOGY IN A NUTSHELL. 


Authorities 

Differ. 


Channels of 
Entrance. 


Period of 
Incubation. 


Why 

Multiplication 

Ceases. 


It must be borne in mind, however, that author¬ 
ities differ as to the mode of entrance of some of 
the bacteria and that theories change as new light 
is thrown on the- subject. The science of bac¬ 
teriology is still rapidly progressing. 

The alimentary canal, the respiratory tract, the 
genital tract, the mucous membranes, wounds 
and the skin, all form channels whereby infection 
is conveyed to the various parts of the body 
which are seats of attack for pathogenic bacteria. 

An incubation period, which varies, in duration, 
is common to all forms of disease caused by the 
invasion of bacteria. During the incubation pe¬ 
riod there are no symptoms of the disease' The 
germs have gained admission to the body by one 
or other channel of entrance and a war is being 
waged between the invaders and the antagonistic 
cells already spoken of as phagocytes. Under 
favorable circumstances the invaders do no harm, 
they are destroyed by their foes and are thrown 
off from the body in the excretions. If the pow¬ 
ers of resistance are weakened in any way, by the 
presence of any other disease, for instance, the 
influence of the phagocytes is lost and the period 
of incubation ends in another period wherein the 
power of the invading bacteria is made manifest 
and symptoms arise followed by more or less 
serious results. 

In each specific disease the infection is thrown 
off from that part of the body which is the seat 
of the invasion. 

During the course of a communicable or spe¬ 
cific disease there comes a time when there is no 
longer any suitable nourishment for the growth 
and development of the micro-organisms and then 
36 


> 


IMMUNITY—ANTITOXINS. 


the disease is starved out. Sometimes the action 
of the germs upon the cells of the body produces 
a condition which is poisonous to the germs them¬ 
selves and thus they are destroyed by the pro¬ 
ducts of their own vital activities. In either 
case the tissues are left in a state of immunity 
from that particular disease for a longer or 
shorter period, sometimes for life. We are told 
of three forms of immunity. 

I. —Natural immunity, which is the natural and 
constant resistance of the antagonistic cells or 
phagocytes to the development within the body of 
pathogenic bacteria. 

II. —Acquired immunity, which is that immun¬ 
ity given to the body, or which the body 
gains, by a single attack of a certain commun¬ 
icable disease. 

III. —Artificial immunity, which is that immun¬ 
ity given to, or gained by the body, through the 
use of antitoxins. 

Antitoxins are antidotes to bacterial poisons. 
These substances are obtained by injecting into 
the body of one of the lower animals, found sub¬ 
ject to the disease, poisons produced by patho¬ 
genic bacteria while developing in broth, bouillon 
or other culture media. After the bacteria have 
remained in the culture media for a stated period 
their poison permeates it. Some of the bouillon 
is then taken and injected into the chosen animal 
(horses, goats, guinea pigs, rabbits, etc., are all 
experimented upon. The horse is preferred for 
the development of diphtheria antitoxin), with a 
special syringe, in very small doses at first which 
are gradually increased until the animal ceases to 
37 


Immunity. 


Natural 

Immunity. 


Acquired 

Immunity. 


Artificial 

Immunity. 


Antitoxins. 



BACTERIOLOGY IN A NUTSHELL* 


Protection. 


Testing. 


Power of 
Antitoxins. 


exhibit any symptoms of the disease, the poison 
of which has been used for the injections. Then 
he is said to be immune or protected from that 
particular disease. Some of the blood of this im¬ 
munized animal is then procured and allowed to 
coagulate and the serum or fluid part is injected 
into other animals or into members of the human 
family, in the same way in which it was used in 
the first instance, until they too become immune 
from that specific disease for a longer or shorter 
period. 

Before using the blood serum of an immunized 
animal on the human subject it is tested on an¬ 
other of the lower animals for the purpose of 
ascertaining its protecting power. If it stands 
the test it is put up in small tubes and tightly 
sealed until required for use. Diphtheria, tuber¬ 
culosis, tetanus, septicemia and other diseases are 
treated by antitoxin inoculations. Antitoxins are 
said to have the power to render inert bacteria 
that may already be present in the subject treat¬ 
ed, or to bring about such alterations in the 
tissues of the body as will prevent their develop¬ 
ment and a cure is the result. 

There are four steps necessary in the prepar¬ 
ation of antitoxins: 

I. —The germs are obtained and grown in a 
proper substance under suitable conditions until 
the toxin or poison is produced. 

II. —The poison is introduced in gradually in¬ 
creased doses until protection is obtained. (A 
dose, we are taught, can be borne toward the last 
of the treatment which if given at first would 
have caused instant death.) Some authorities 
tell us the process takes from three to sir months. 

38 


koch's circuit. 

Others give the period as from six months to two 
years. 

III. —Some of the blood of the immune animal 
is next obtained; aseptic precautions are observed 
during its removal. After coagulation the serum 
is taken and its protecting power tested on other 
lower animals. 

IV. —It is put up in sterile tubes and carefully 
and aseptically sealed, ready for use of the human 
subject. 

The antitoxin treatment is somewhat similar 
in its effects to vaccination as a protection against 
smallpox. The theory has been advanced that 
vaccination against diphtheria and other com¬ 
municable diseases may come to be an established 
method during epidemics. 

It is claimed by Koch that in order to prove 
that a certain germ or micro-organism is the 
cause of a specific disease it must produce certain 
effects. Briefly, these are as follows: 

I. —Where the disease is present there the 
specified germ must always be found. 

II. —The germ found in the diseased body 
must again grow and multiply in proper culture 
media outside of the body. 

III. —The same disease must be reproduced in 
a healthy animal by using the poison or toxin ob¬ 
tained from the culture media in which the germ 
has multiplied. 

IV. —The same germ must again be found in 
the serum of the blood of the animal thus inocu¬ 
lated as a result of the process. 

Koch further states that it must be proven that 
no other germ is capable of producing the disease 
under consideration and that if the original 
39 


Vaccination. 


Koch’s 

Circuit. 


Bacteriology in a nutshell. 

micro-organism is not found all through the pro¬ 
cess the suspected disease does not exist. 


SUMMARY OF CHAPTER IV. 


Parkes’ list of diseases due to bacterial inva¬ 
sion. How they are communicable. 

Authorities have different opinions on this 
point. 

Manner in which bacteria gain an entrance to 
the human structure. 

The periods of incubation, invasion and devel¬ 
opment of disease if the bacteria are not over¬ 
come by the phagocytes. 

How infection is thrown off from the healthy 
body. 

Death of bacteria through lack of nourishment 
and other causes. 

Immunity: Natural, acquired, artificial and 
definitions. 

Antitoxins: Where they are obtained and how 
they are prepared. 

Koch’s Circuit. 


QUESTIONS FOR REVIEW.-CHAPTER IV. 


I. —How are diseases designated in the classes 
mentioned ? 

II. —Define inoculation. Surface lesion. Air¬ 
borne. 

III. —Mention channels through which infec¬ 
tion is communicated to the body. 

40 






SUMMARY AND REVIEW. 

IV. —What do you understand by “period of 
incubation?” “Seat of invasion?” 

V. —Explain the conditions under which symp¬ 
toms of diseases due to bacteria arise ? 

VI. —What becomes of the invading- germs if 
overcome by the phagocytes ? 

VII. —How do bacteria work their own de¬ 
struction ? 

VIII. —In what other way may their multipli¬ 
cation within the body be arrested, and their death 
result ? 

IX. —Describe antitoxins in detail, their devel¬ 
opment and use? What -effects should be ex¬ 
pected to follow the antitoxin treatment? 

X. —What is Koch’s germ theory? Describe 
the complete circuit in detail. 


4i 



Contagious 

and 

Infectious. 


Communicable 

Diseases. 


Bacillus 

Typhosus. 


In former years communicable diseases were 
spoken of as either contagious or infectious dis¬ 
eases. The term contagious was applied to those 
diseases which are transmitted by direct contact 
or inoculation; infectious to those which are 
either air or water borne. It has been developed 
by experience that many of the diseases which 
were called infectious can also be transmitted by 
contact or inoculation and also that those diseases 
termed contagious are sometimes air or water 
borne, hence the apparent necessity for the change 
to the term communicable which is used to cover 
all diseases that may be transmitted or commun¬ 
icated from a sick to a well person without refer¬ 
ence to the method of transmission or commun¬ 
ication. 

Among the communicable diseases commonly 
met with by the nurse we will first mention 

Typhoid Fever. The invading micro-organ¬ 
ism in this disease is the bacillus typhosus, dis¬ 
covered by Eberth and Koch and sometimes 
called Eberth’s bacillus in honor of one of its dis¬ 
coverers. The seat of invasion in typhoid fever 
is the small intestine in the lower part of what is 
known as the ilium, situated near the ileo-caecal 
42 



COMMON COMMUNICABLE DISEASES. 

valve. The bacillus first attacks certain structures 
termed the Peyerian glands (also termed “Pey- 
er’s patches,” after the anatomist who first dis¬ 
covered or described them). These glands are 
small white looking patches, or groups of lymph 
follicles, (tiny sacs containing great numbers of 
small, round cells and some fluid) in the mucous 
and submucous layers of this part of the small 
intestine. As a result of the attack, the 
Peyerian glands inflame, swell, thicken and 
frequently ulcerate. When ulceration occurs 
sloughing or casting off of dead particles 
of tissue follows and an open sore is left behind. 
Sometimes a blood vessel is punctured by an 
ulcer, when a hemorrhage more or less severe in 
its effects takes place. An ulcer may, and fre¬ 
quently does, extend through the entire wall of 
the intestine, when perforation and the escape 
of the intestinal contents into the abdominal cav¬ 
ity causes peritonitis and death, unless the per¬ 
foration is such as can be repaired and the pa¬ 
tient is in a condition to warrant such a measure. 

While the small intestine is said to be the chief 
seat of the bacterial invasion, the various systems 
of the human structure are also affected. There 
is elevation of temperature, owing to absorption 
of poison produced by the bacillus typhosus, and 
the patient frequently suffers from thirst. 

A disordered condition of the nervous system 
exists, manifested by headache, insomnia, and in 
severe cases by delirium and unconsciousness. 

The digestive system is affected and in conse¬ 
quence we observe, loss of appetite, a furred 
tongue and sometimes nausea and vomiting. At 
times there is a severe diarrhoea present, at other 
43 


The Peyerian 
Glands. 


Changes 

Produced. 


Hemorrhage. 


Perforation 

and 

Peritonitis. 


Absorption 
of Poison. 


The Nervous 
System. 


The Digestive 
System. 


BACTERIOLOGY IN A NUTSHELL. 


The Circulat¬ 
ory and 
Respiratory 
Systems. 


The Skin. 


The Muscular 
System. 


The Urine. 


Excretion of 
Germs. 


Common 
Methods of 
Communication. 


times constipation may exist. 

There are disturbances, too, of the circulatory 
and respiratory systems. The heart beats more 
rapidly and there is a corresponding increase in 
the pulse rate. There are characteristic changes 
in the respiration, also, very often. 

Changes in the skin are apparent, and it is 
usually found to be hot and dry during the height 
of the fever. 

The changes in the muscular system are shown 
by their thin, flabby condition, which is especially 
noticeable if the disease runs a prolonged course. 

Changes are observed in the urine owing to an 
increase of the solids contained therein. It is 
highly colored and diminished in quantity 
usually. 

The germs of typhoid fever are thrown off in 
the evacuations from the bowels, in the urine, in 
vomited matter and are sometimes found in the 
sputum and sordes (foul substance which col¬ 
lects on the teeth and gums of fever patients). 
Flies are said to distribute the infection. The 
common method of communication is through 
contaminated drinking water and food supplies. 
Milk has been found to contain the germs and 
they are said to multiply rapidly therein. *Milk 
may be contaminated (i), because the cows are 

*In the best dairies and creameries now-a-days the 
milk is Pasteurized in sterile receptacles. Water used to 
wash the butter is boiled in covered apparatus, and then 
cooled to the proper temperature in specially constructed 
refrigerators. Special care is taken to sterilize all cans, 
pails, etc., used for the milk and butter. The cows are 
kept clean, and the milkers’ hands and clothing also, 
both in milking and in handling the milk afterwards. 
Butter made in these dairies and creameries, accord¬ 
ing to agricultural journals, keeps months longer than 
when made and taken care of in the old fashioned way. 

44 



COMMON COMMUNICABLE DISEASES. 

not kept clean; (2), because milk pails, cans or 
Other vessels in which milk is kept are not thor- Contaminated 
oughly cleansed and boiling water poured into Milk, 
and over them before using; (3), because the 
dairy is not kept pure or persons handling the 
milk are not careful; (4), because water, which 
some dishonest dealers are said to put in the 
milk they sell, may contain the germs. Epi¬ 
demics of the disease are common and are often 
traced to a contaminated water supply. Hence 
the necessity for filtering and boiling the water Sterile 
used for drinking and in preparing foocT, espe- ^^ r ing 
dally during epidemics. We cook our foodstuffs 
to make them safe, and use sterile water to 
cleanse fruits and vegetables which come to the 
table uncooked. We keep milk and meats, unless 
already contaminated when purchased, un¬ 
harmed by placing them on ice. An epidemic The Butler 
of typhoid fever occurred in Butler, Pennsyl- Epidemic, 
vania, in 1903, the horrors of which are still 
fresh in our memories. The death rate was 
enormous. Many nurses lost their lives. A11 
infected water supply was the cause. 

Great care is necessary on the part of the Prophylaxis 
nurse who attends typhoid fever patients to guard 
all sources of infection under her immediate con¬ 
trol. Stools and urine and vomited matter must 
be thoroughly disinfected before they are emp¬ 
tied. Use a sufficient quantity of good disin¬ 
fectant solution, boiling water, milk of lime, car¬ 
bolic acid, etc., (See Chapter VII for disinfect¬ 
ants), to completely saturate the mass. Cover 
the vessel and allow it to stand for an hour be¬ 
fore disposing of its contents. Thoroughly 
cleanse and disinfect the vessel and its cover 
45 


BACTERIOLOGY IN A NUTSHELL. 


The Patient’s 
Room. 


Personal 

Hygiene. 


each time after using and as a matter of precau¬ 
tion keep a small quantity of a disinfectant so¬ 
lution in all vessels preparatory to using again. 
Use a separate thermometer for typhoid fever 
patients and also separate syringes and rectal 
tubes. Keep the thermometer in a bichloride 
solution, 1-1,000, renewed: daily. Be very par¬ 
ticular to cleanse the rectal tubes and syringes 
and boil them every day. Never turn syringe 
nozzles inside of syringes after using. Remove 
the nozzles; scrub well with soap and hot water 
before boiling. They should be kept in a carbolic 
acid solution, 1-40, with the rectal tubes. This 
solution must also be prepared anew once in 
twenty-four hours. See that bed and body linen 
and towels are disinfected before placing in the 
laundry with the ordinary wash. Burn all pieces 
of old linen or absorbent cotton used to cleanse 
the mouth and teeth and lips. Use listerine, 
borolyptol or other good solution for this pur¬ 
pose. Give particular attention to disinfection 
of the sick room at the close of the case and of 
everything it contains. 

In nursing private cases outside the hospital 
when preparing your patient’s room ask permis¬ 
sion fto remove all unnecessary furniture and 
draperies, etc., which may serve as lurking places 
for germs. Explain when you ask permission 
why you would like to have the room as nearly 
on the hospital order as possible. If you are al¬ 
lowed a choice of rooms, one on the south side of 
the house is preferable and as far removed from 
noise and disturbance as you can get it. 

Take care of your own health. Be very 
careful to thoroughly wash and scrub your hands 
46 


COMMON COMMUNICABLE DISEASES. 

(particularly your nails, beneath which are fav¬ 
orite hiding places for germs), and disinfect them 
each time you attend to the evacuations. Never 
touch your face with your hands after such work 
until they have been carefully cleansed and dis¬ 
infected. A tiny speck of any one of the dis¬ 
charges may be deposited upon the face or lips 
and gain an entrance to the body with disastrous 
consequences to you. Be watchful of like dan¬ 
gers when giving baths, enemas and in cleansing 
the lips, the teeth and the mouth of your patient. 
Pay strict attention to personal disinfection be¬ 
fore going from a communicable disease to an¬ 
other case. 

Keep your patient’s person, bed, bedding and 
room absolutely neat and clean . Wipe all wood¬ 
work and furniture with a cloth wrung out of a 
disinfectant solution. Pay strict atten¬ 
tion to ventilation. Remember that neatness 
and cleanliness are necessities, and that an abun¬ 
dance of fresh air and sunshine are Nature’s 
own disinfectants. Two to three thousand cubic 
feet of fresh air are required in all sick rooms; 
the latter amount is obtainable in a room fifteen 
feet wide by twenty long, with a ceiling eleva¬ 
tion of ten feet, but the current must be changed 
every hour in order to keep the atmosphere pure. 
Your patient can be protected by a screen from 
her possible fear of ‘'catching cold” while you 
open up the windows from the bottom. They 
should be kept open a few inches at the top all the 
time. All “disease germs” multiply rapidly in a 
room kept dark, dingy and badly ventilated, and 
where papers, books, and rubbish are allowed to 
accumulate. The sick one takes these germs into 
47 


General 

Precautions. 



“Widal’s 

Test.” 


BACTERIOLOGY IN A NUTSHELL. 

.V 

the system again and the disease is both aggra¬ 
vated and lengthened. *Study to acquire right 
methods of bathing in this disease. 

The care and watchfulness necessary in nurs¬ 
ing typhoid fever holds good in nursing all germ 
diseases. It will therefore be unnecessary to 
speak of these at length when dealing with other 
communicable diseases. 

A Blood Test. If there is reasonable doubt 
as to the disease from which a patient is suffer¬ 
ing being typhoid fever, a test discovered by 
Widal of the University of Koenigsberg, is some¬ 
times resorted to. 

Widal’s Test is based upon the fact that the 
blood serum of a person who has typhoid fever 
is antagonistic to the bacillus typhosus. A drop 
of blood is obtained from the suspected patient 
by pricking the lobe of his ear. This drop is 
placed on a clean glass slide and covered imme- 

*While it is not the purpose of the writer to speak 
of methods of treatment given in diseases caused by 
bacterial invasion, several years experience in training 
nurses has revealed the fact that many pupils fail to 
grasp the proper methods of applying hydrotherapeutics 
when nursing typhoid fever. If the physician orders 
tub baths, they seem to fail to recognize the necessity 
for using friction systematically in order to bring about 
the requisite reaction. When they do use friction, they 
go about it in such a haphazard fashion that frequently 
there is an increased elevation of temperature instead 
of a decreased, and the nervous symptoms at the end 
of the treatment are more pronounced than before be¬ 
ginning it. (This does not refer to patients whose 
peculiarities of constitution were such as to contra¬ 
indicate “tubbing,” but to those who, when properly 
handled, responded admirably). In giving sponge 
baths, also, very often the right method of sponging 
is not observed. It seems to be necessary for nurses 
who are training pupils to pay particular attention to 
practical teaching in this direction. 

48 








COMMON COMMUNICABLE DISEASES. 

diately to prevent other germs which may be 
lurking about from getting into it, and it is then 
allowed to dry. A little of the boullion, or other 
substance, in which the bacillus typhosus is be¬ 
ing cultivated is then placed on another clean 
glass slide and covered. The dried blood of 
the suspected patient is made into a watery solu¬ 
tion and added to the culture. From this mix¬ 
ture of dried blood and typhoid bacillus, what 
is known as a “hanging drop” preparation is 
made under the microscope. If the patient has 
typhoid fever the bacilli will be seen rapidly to 
lose their power of motion and to form into 
tangled clumps, or masses, and so get 
away from the blood serum of the patient. If 
typhoid fever does not exist, this clumping and 
entanglement of the bacilli and arrest of their 
movements does not occur. There is said to be 
an exception to this rule in cases where the 
patient has had the disease recently, under 
which circumstance the reaction may occur 
without such evidence of the onset of a new 
attack. 

Cholera is caused by Koch’s comma bacil¬ 
lus. Dysentery, a somewhat similar disease, is 
caused by the bacillus dysenteriae—both of these 
diseases are contracted through the same sources 
as typhoid fever is contracted, and the same 
watchfulness against its spread must be rigidly 
carried out; also the same precautions as to per¬ 
sonal cleanliness and neatness with regard to the 
nurse, patient, and patient’s room. Be especially 

*German authorities spell this scientists name Vidal, 
and assert that he is French and that the American 
spelling, “Widal,” has arisen because of the German 
pronunciation of the letter V. 

49 


Exception to 
*Widal’s Test. 


Cholera and 
Dysentery. 


BACTERIOLOGY IN A NUTSHELL. 


Sources of 
Infection. 


Intubation 

and 

Tracheotomy. 


careful to let the pure air and sunshine have 
free access at all times, and remember the dan¬ 
ger from impure water. Epidemics of cholera 
from that source are not common here. An 
epidemic occurred in Hamburg, Germany, in the 
months of August and September, 1892, when 
nearly nine thousand deaths were reported dur¬ 
ing the two months. The epidemic was believed 
to be due to the infection of the river from 
which that city obtains its water supply. Gipsies 
had camped on the river banks, and., as. they 
had a case of cholera in their midst, the trouble 
was thought to have arisen from that source. 

Diphtheria. The bacillus diphtherise, the 
micro-organism of diphtheria, can be taken into 
the system in food. It may also be communi¬ 
cated from the sick to the well directly from the 
mouth, indirectly through the infected dishes, 
spoons, or other similar articles, or the infection 
may be breathed in. The germs are found in 
the discharges from the nose and throat. The 
nurse must be careful to avoid having the pa¬ 
tient cough in her face, as particles of membrane 
dislodged from the throat are a fruitful source 
of danger, especially so to both physicians and 
nurses during operations on the throat, tracheot¬ 
omy and intubation of the larynx, for the relief 
of patients suffering from this dread disease. 

While the seat of invasion in diphtheria is 
usually the throat, other parts of the body suffer 
also, which is always the state of affairs in se¬ 
vere germ diseases. A common sore throat 
forms a good camping ground for the diphtheria 
bacillus and the deadly work is accomplished 
very rapidly in many instances. Patients some- 
50 


COMMON COMMUNICABLE DISEASES. 


times die before their danger is realized by the 
uninitiated. Suffocation, heart failure and ex¬ 
haustion are immediate causes of sudden deaths. 
The nurse must be ever on the alert for symp¬ 
toms of approaching danger from any of these 
sources. 

Disinfect all discharges from the throat and 
nose. Observe carefully the precautions with 
regard to patient and room, sunshine, ventila¬ 
tion and disinfection at the close of case. Be 
careful to protect your patients from any possi¬ 
bility of drafts striking them. Use a screen 
about the bed. No patient’s bed should be so 
placed as to be in a current of'an*. A room prop¬ 
erly ventilated is not “drafty” of necessity. 

Membranous croup and whooping cough are 
contracted in the same way as diphtheria, and 
are spread by the same means. Moist air is ne¬ 
cessary in the patient’s room in most cases of 
diphtheria, whooping cough and croup to relieve 
the throat symptoms. 

INFLUENZA OR LA GRIPPE. 

The bacillus of this disease finds an entrance 
to the system through the respiratory tract. 
Sources of infection are the discharges from the 
throat and nose, which should always be disin¬ 
fected. 

There are several forms of “la grippe,” notably 
the catarrhal, bronchial and intestinal forms. In 
the intestinal form, some physicians advise disin¬ 
fection of the evacuations also. This is one of 
the few germ diseases which one is apt to con¬ 
tract very frequently. No number of attacks will 
afford immunity. Epidemics are common, 

5i 


Disinfect and 
Ventilate. 


Membranous 
Croup and 
Whooping 
Cough. 


Various 

Forms. 


BACTERIOLOGY IN A NUTSHELL. 


Methods of 
Communica¬ 
tion. 


Domestic 

Animals. 


Sources of 

Communication 

Unknown. 


SCARLET FEVER, MEASLES, GERMAN MEASLES, 
CHICKEN POX. 

The germs causing scarlet fever, measles, Ger¬ 
man measles (Roseola) and chicken-pox are 
found in the secretions from the nose and throat 
and in the desquamating (peeling or flaking) 
skin. The disease can be contracted through 
direct contact with the afflicted person, articles 
used in the sick room, such as books, toys, cloth¬ 
ing, food or dishes, and also in the dust and 
sweepings of the ward or room. This is espe¬ 
cially true of scarlet fever and measles, and the 
nurse needs to be more than ordinarily cautious, 
as the disease can be communicated to the well 
just as long as any desquamating skin remains. 
Disinfection before desquamation ceases is prac¬ 
tically a waste of time. Cats and dogs are be¬ 
lieved to carry the germs in their coats and 
should be kept out of the sick room. Use car- 
bolized oil as an inunction in all of these dis¬ 
eases to prevent or lessen the danger from float¬ 
ing particles of skin. Gowns and bed linen, 
which are full of these particles, should be re¬ 
moved carefully and placed at once in a 
disinfectant solution. Do not shake them 
about the room. Dust all furniture with a cloth 
wrung out of a disinfectant. Destroy all toys, 
books, etc., used by a scarlet fever patient, by 
fire preferably. Be very thorough in personal 
disinfection before going to another case. 

Mumps. In mumps it is deemed wise to dis¬ 
infect discharges from the throat and nose. Al¬ 
though it has not yet been proven how the dis¬ 
ease is contracted, it is conceded by all to be a 
communicable disease. 


52 


COMMON COMMUNICABLE DISEASES. 


Tetanus, commonly called “lockjaw,” is caused 
from the invasion of wounds by a germ known as 
bacillus tetani, usually found in the soil near the 
surface. The poisonous matter is thrown off 
through the pus discharged from the wounds. 
We frequently meet with cases of tetanus caused 
by the patients having stepped on a nail protrud¬ 
ing from a board lying in their pathway. The 
nail has penetrated the shoe, entered the foot 
and carried with it particles of soil containing 
the germs. The bacillus tetani is said to pos¬ 
sess the power to do its deadly work in as short 
a period as twenty-four hours, and but rarely to 
cause mischief later than the tenth day after the 
accident. 

In the past few years a number of cases of 
tetanus have occurred after Fourth of July cele¬ 
brations, arising in wounds caused by toy pistols. 
Blank cartridges of these toys are said to con¬ 
tain the germs, although authorities are of the 
opinion that the germs are probably upon the 
soiled hands of the child before the accident and 
that they cause trouble in the wound afterward 
just as they do in other gunshot accidents in 
which tetanus arises. A law was passed last 
year in many of the large cities of the United 
States prohibiting the sale of these pistols. 

The throat and jaws seem to be the parts most 
affected when the symptoms first appear. A feel¬ 
ing of stiffness and sometimes of pain in these 
parts is complained of. Rapidly the stiffening of 
the jaws increases. Severe muscular spasms de¬ 
velop, at first in the muscles of the jaw, but soon 
to spread over the entire muscular system. The 
spasms increase in rapidity and severity until 
53 


Bacillus 

Tetani. 


Fourth of 
July Toy 
Pistols. 


Symptoms. 


BACTERIOLOGY IN A NUTSHELL. 


Arching of 
the Back. 


Effect of 
Medicines. 


Management 
of Tetanus. 


Preventive 

Measures. 


they are kept up almost continuously. (The 
spasms seen in tetanus are somewhat similar to 
the spasms from strychnia poisoning.) Eventual¬ 
ly the jaws become tightly clenched, the back is 
bowed and the patient is frequently found to rest 
only on the back of his head and his heels, the 
rest of the body arching upward from the bed. 
Death commonly occurs from exhaustion. The 
majority of cases prove fatal. 

Medicines seem to have no effect in arresting 
the progress of tetanus. Chloroform and opiates 
are used by many physicians for the temporary 
relief they give from the violence of the spasms. 
In recent years the antitoxin treatment has saved 
some lives. In order to be of any marked value 
it must be administered early in the case. 

The nurse is instructed to keep the patient’s 
room darkened and to guard him from all dis¬ 
turbances. Noises are said to aggravate the 
spasms, and she is cautioned to keep him quiet. 
He should be watched very closely and must not 
be left alone a minute. Strenuous efforts to give 
him nourishment must be made. As the jaws 
are tightly clenched, recourse is had to nutrient 
enemata. “Nose feeding” is not recommended 
by the best authorities, as it is believed to aggra¬ 
vate the spasms. Opiates are sometimes given 
by rectal injection also. 

Some physicians now recommend opening up 
accidental wounds as quickly as possible after 
they occur. A thorough irrigation of the wound 
with an antiseptic solution then follows, such 
irrigation to be kept up at frequent intervals un¬ 
til all danger of the invasion of the bacillus te- 
tani is over. Between the irrigations, the 
54 


COMMON COMMUNICABLE DISEASES. 


wound is protected by an aseptic dressing held 
in place by a bandage. 

Erysipelas, at one time regarded as an acute 
inflammation of the skin, is now attributed to 
the invasion of the system by the streptococcus 
pyogenes* which gains an entrance through 
wounds, and sometimes through scratches or 
punctures of the skin so tiny as to be almost im¬ 
perceptible to the naked eye. The disease is 
spread by means of small particles of desquamat¬ 
ing skin from the affected part floating in the air 
and by pus from the wound in some cases. It is 
carried from one person to another by actual 
contact, clothing, or other infected articles, such 
as bedding, towels, dressings, and anything used 
by patients. It may also be communicated by 
the hands of the physician or nurse or by instru¬ 
ments used in treating the case. All such outlets 
and inlets of this most mischievous germ must be 
well guarded by the nurse. Burn all old dress¬ 
ings immediately and use disinfectants rigidly 
throughout the case and at the close of the case. 

While the erysipelas germ is liable to attack 
wounds, the disease frequently appears where 
there is no perceptible wound. A rose-red blush 
of the skin is seen. The edges of the affected 
area are clearly distinct from the healthy sur¬ 
roundings. There is usually a swollen condition 
and the sick one complains of a tightness and 
stiffness in the diseased region. Erysipelas 
spreads rapidly when it attacks loose tissues, such 
as those of the face, and preventive applications 

♦When the streptococcus pyogenes invades the skin 
we have erysipelas; when it invades the blood, we 
have septicemia or “sepsis,” and other inflammations in 
which suppuration occurs. 

55 


Cause of 
Erysipelas. 


Channels 
of Outlet. 



BACTERIOLOGY IN A NUTSHELL. 


Alcoholic 

Subjects. 


Methods of 
Entrance. 


Predisposing 

Causes. 


have to be made early in the case. It is a very 
severe disease in some instances, particularly so 
in persons addicted to the habit of using alco¬ 
holics to excess. 

Various parts of the system are affected as 
shown by elevation of temperature, nausea, and 
frequently vomiting, headache, rapid pulse, and 
after the disease is well advanced in bad cases 
there may be delirium and exhaustion. The dis¬ 
ease sometimes proves fatal. 

Tuberculosis. All forms of this disease, 
which attacks various parts of the human struc¬ 
ture, are caused by the bacillus tuberculosis. 
Tuberculosis of the lungs is called phthisis or 
consumption. When the germs attack the lym¬ 
phatic glands the disease is spoken of as scrofula. 
Tuberculosis of the skin is termed lupus. The 
nurse meets with tubercular joint disease, tuber¬ 
cular disease of the kidneys, tubercular menin¬ 
gitis, tubercular peritonitis and so forth. 

The germ which is responsible for the develop¬ 
ment of tuberculosis generally gains admission 
to the system through breathing in air in which 
they are circulating, but it may be taken in 
through other sources; for instance, by drinking 
milk containing the germs. Jersey cows are said 
to be subject to tuberculosis and their milk apt 
to contain the germs. Wounds also admit the 
germs. 

Persons predisposed to tuberculosis are those 
whose chests are not well developed, whose cir¬ 
culation is poor and whose vitality is low, par¬ 
ticularly if their surroundings and occupations 
are unhealthy. Those who have to work in 
dusty, overheated, badly ventilated rooms, for 
56 


COMMON COMMUNICABLE DISEASES. 


example. Insufficient or poor food is given as 
another cause favoring the development of the 
disease. When one of these causes, or several 
of them, weaken the structure, power of re¬ 
sistance is lessened, and when the germs gain 
an entrance we fall an easy prey to the ravages 
of the disease, if they are not sought after and 
driven out at an early stage. 

The duties of the nurse when caring for a 
tubercular patient are to thoroughly disinfect all 
sputa, cleanse and disinfect all sputa cups, and to 
destroy by tire all dressings used on tubercular 
wounds. Many physicians demand that sputa he 
burned also, and special sputa cups are now in 
use with a detachable water-proof lining made of 
a sort of pasteboard. These linings are put up in 
packages which come with each sputa cup. They 
are easily slipped in and out and are changed 
several times a day. They are burned immediate¬ 
ly on removal from the cup. Bed and personal 
clothing (particularly handkerchiefs) must be 
treated to a bath of boiling water or well soaked 
in a good disinfectant solution before placing in 
the general wash. While tubercular patients are 
not isolated in the same sense in which scarlet 
fever or diphtheria patients are, they should oc¬ 
cupy separate bedrooms and the use by others 
of a tubercular patient’s dishes should be discour¬ 
aged. 

Keep your patient out of doors in the fresh air 
and sunshine as much as possible. “Out of doors 
all the time, and sleep and eat in the open air in a 
proper climate” is getting more and more to be 
the prescribed treatment. To which is added as 
indispensable, plenty of nourishing, easily-digest- 
57 


Early 

Precautions. 


Fresh Air 
Treatment. 


BACTERIOLOGY IN A NUTSHELL. 


The Mosquito 
Anopheles. 


Plasmodium 

Malariae. 


Length of 
Days and 
Multiplication. 


Mode of 
Communica¬ 
tion. 


ed food, perfect cleanliness and neatness of per¬ 
son and surroundings and a cheerful atmosphere 
at all times. The nurse who pays strict attention 
to all of these requisites is a valuable and valued 
assistant to the physician fighting this disease. 

Malaria. Malaria is now classed as a disease 
of bacterial origin and is believed to be carried 
from the sick to the well by a species of mosquito 
—the anopheles. Those who live in low, damp 
localities or near “swampy” regions are more apt 
to be attacked. The germ to which the poison 
of malaria is said to be due is called plasmodium 
malariae. These germs get into the red cor¬ 
puscles of the blood, live upon them, and de¬ 
stroy them. We are taught that there are three 
varieties of the malaria germ, one of which lives 
in the human structure seventy-two hours, and 
the. other two forty-eight and twenty-four hours 
respectively. Their death, sad to say, does not 
mean the end of the mischief they accomplish, 
as when they cease to exist themselves they di¬ 
vide up into a number of tiny particles or seg¬ 
ments each of which means a new life or germ. 
These new germs attack other red corpuscles 
and live upon them until they, too, die, but in 
dying they form new parasites, as their parent 
germs did before them. Each fresh set of 
germs destroys a large number of the red 
corpuscles. 

Koch, and other scientists, who teach that the 
germ is carried by mosquitoes, believe they slake 
their thirst in infected pools in swamps and then 
alighting on healthy bodies they communicate to 
them the disease—producers by inoculation. 
Thev also teach that these mosquitoes carry the 
58 


COMMON COMMUNICABLE DISEASES. 


poison in the same way from the sick to the 
well. Prevention is only possible by destroying 
the mosquitoes. 

Cerebro-Spinal Meningitis is caused by the 
diplococcus intracellularis meningitidis. It is 
not communicated from the sick to the well in 
the same manner in which most communicable 
diseases are, and the germs are not found in the 
excretions unless there are lesions formed either 
of the brain or spinal cord. The exact method 
by which the germs enter and leave the struc¬ 
ture has not been fully decided upon by scien¬ 
tists, but nurses are instructed that it is safest to 
disinfect all discharges from the body, all per¬ 
sonal clothing and bed linen; also to fumigate 
the room at the close of the case. 

The seat of invasion in cerebro-spinal menin¬ 
gitis is in the membranes which cover and enclose 
t:ic brain and spinal cord. The germs set up an 
inflammation of these membranes, which are 
known as the meninges, but the poison is also 
distributed to other parts of the body. Inflam¬ 
mation of the meninges is a characteristic symp¬ 
tom by which the disease is made manifest. 
Sometimes only a small portion is afifected, at 
other times the greater part of the cerebral sur¬ 
faces are involved. This is one of the very few 
diseases in which the nurse is told that lack of 
strict personal cleanliness, so far as the patient 
is concerned, must sometimes be permitted be¬ 
cause of the necessity for absolute rest and free¬ 
dom from all movement. 

About one-half of the number of cases of cere¬ 
bro-spinal meningitis end in death, and about 
tnree-fourths of its victims are children under 
59 


The Germ a 
Diplococcus. 


Seat of 
Attack. 


bacteriology in a nutshell. 


The Germ of 
the Disease. 


Why Named 
for Pneumonia. 


ten years of age. There have been epidemics of 
the disease in the United States. One of the most 
appalling occurred in a small town in Pennsyl¬ 
vania (population 6,000) in 1864, when it is said 
that some four hundred children lost their lives. 
The very best medical attention and most careful 
nursing are necessary to bring about recovery. 

Pneumonia. Pneumonia is one of the most 
serious of all diseases due to the invasion of 
the human structure by bacteria. The special 
germ to which this disease owes its origin is the 
diplococcus pneumonia, or “Fraenkel’s diplococ- 
cus lanceolatus,” which is also said to producer- 
meningitis, pleurisy and ulcerative endocarditis. 
The disease produced in all cases is an in¬ 
flammation, the manifestation of which 
is modilied by the portion of the body in¬ 
vaded. Pneumonia is an inflammation of the 
lungs, sometimes of one or more of the lobes of 
one lung, sometimes of the lobes of both lungs, 
or it may be an inflammation of all of both lungs. 
Endocarditis is an inflammation of the endocar¬ 
dium or membrane lining the heart. Meningitis 
is an inflammation of the meninges or mem¬ 
branes which enclose and cover the brain and 
spinal cord. These various organs have various 
functions; this function is interfered with when 
the organ becomes inflamed and the symptoms 
are different, while the cause may be the same. 
The germ was discovered first in the lungs in 
pneumonia and took its name from that disease. 
As was mentioned in Chapter I, broncho-pneu¬ 
monia is often caused by other germs, but au¬ 
thorities are of the opinion that in genuine, 
acute, lobar pneumonia the diplococcus pneu- 
60 


COMMON COMMUNICABLE DISEASES. 

monia is always present. The germ is a very 
common one. It is found in the dust and 
sweepings of rooms and is frequently present 
in the .mouths of the healthy. Exposure to se¬ 
vere weather or dampness which has produced a 
heavy cold acts as a predisposing cause. The 
system is invaded, resistive power weakened, 
and an attack of pneumonia follows. The germs 
enter the lungs through the respiratory tract, 
often causing disastrous changes in these or¬ 
gans. The poison is eliminated from the sys¬ 
tem through the secretions from the seat of the 
disease, usually the sputum, which should be 
disinfected or burned as in tuberculosis. 

Pneumonia has been called the "Captain of 
the Men of Death,” because it carries off annu¬ 
ally more victims than any other disease. In few 
other forms of illness is such constant care and 
watchfulness on the part of the nurse demanded 
as in pneumonia. The disease usually ends by 
crisis, when collapse or great prostration of all 
the vital forces may occur. Or the patient may 
die during the course of a severe form of the dis¬ 
ease from suffocation or heart failure. Such pa¬ 
tients must not be left alone under any considera¬ 
tion. Heart failure is, perhaps, a point especially 
to be impressed upon the nurse, as any sudden 
exertion or excitement on the part of the patient 
may bring about the dread calamity. One at¬ 
tack of pneumonia instead of affording immun¬ 
ity, seems to predispose to other attacks. 

Relapsing Fever. The micro-organism which 
causes relapsing fever, discovered by Ober- 
meier in 1873, is termed Spirocheta Obermeieri. 
Scientists are of the opinion that the disease is 
61 


Predisposing 

Influences. 


Entrance and 
Excretion. 


Importance of 
Nursing. 


Immediate 
Causes of 
Death. 


Obermeier’s 

Germ. 


Method of 

Communication 

Uncertain. 


Impure 
Water and 
Mosquitoes. 


Prevention. 


Cause. 


BACTERIOLOGY IN A NUTSHELL. 

carried from the sick to the well by the bite of 
insects, although the actual method has not been 
fully determined. An epidemic of relapsing 
fever occurred in New York and Philadelphia in 
1869. It is not a common disease in recent years, 
and epidemics unheard of, owing to improved 
sanitary conditions. 

Filariasis is a disease due to the filiaria san¬ 
guinis hominis, a small worm-like parasite. It is 
admitted to the body, usually, through the ali¬ 
mentary canal in impure drinking water. Mos¬ 
quitoes are believed by some authorities to cause J 
a spread of the disease by the inoculation of their 
victims with the blood of diseased persons. The 
seat of the disease is the deeper lymphatics. v 
Prominent symptoms are chyle in the urine, 
oedema of the skin (swelling due to effusion into 
connective tissue), and hypertrophy (morbid en¬ 
largement) of the cellular tissues, known as “ele¬ 
phantiasis.” 

Prevention consists in removing the sources 
whereby drinking water is contaminated and in 
destroying the mosquito. 

Yellow Fever. While yellow fever is not a 
disease commonly met with by the nurse in this 
part of the country, we will speak of it briefly in 
this connection. It is a disease which is very 
rapidly spread by means of a species of mosquito, 
the stegomia fasciata. These insects transmit 
the germs by direct inoculation of blood from the 
sick to the well. The disease is not air borne, 
nor is it carried in clothing, books or other such 
articles. The mosquitoes must be destroyed in 
order to prevent the spread of the disease. 

In the Southern States and in Mexico, where 
62 





COMMON COMMUNICABLE DISEASES. 


epidemics of yellow fever occur every year, phy¬ 
sicians surround the beds of patients suspected 
to be developing the disease with a netting to 
prevent the onslaughts of the mosquitoes. Dr. 
Walter Wyman, surgeon of the U. S. Marine 
Hospital, in speaking of the disease in Texas and 
in Mexico, says that it is necessary to screen the 
beds of “suspects” because it is not possible to 
tell until the fifth day whether or not the disease 
is the “dread yellow variety” which is communi¬ 
cable only “during the first three days” Strenu¬ 
ous efforts are being made by the health officers 
in all parts of Texas and Mexico to exterminate 
the pestilence-breeding and disease-carrying mos¬ 
quitoes. Water barrels, which are much used 
in these places and which form favorite haunts 
for the mosquitoes, are screened also: v All pools 
and swamps are treated with oil and in some 
places drained and filled in. 

Bubonic Plague is caused by the bacillus pes- 
tis. This germ has the power to enter the body 
through wounds, the alimentary canal, or the res¬ 
piratory tract. The infection is thrown off in 
the pus from wounds, in sputum and in dis¬ 
charges from the body. When a wound is in¬ 
vaded by the germs, a severe local inflammation 
results and quickly spreads to the lymphatic 
glands. Flies and other insects are said to trans¬ 
mit the disease. 

Smallpox. The micro-organism which causes 
smallpox was reported as discovered by Dr. 
Wm. T. Councilman, of Harvard College, Bos¬ 
ton, Mass., in the early spring of 1904. He 
made known his discovery during the course of a 
lecture given in that city on “The Aetiology of 
63 


Preventive 

Measures. 


The Bacillus 
Pestis. 


Discovery of 
the Germ. 


BACTERIOLOGY IN A NUTSHELL. 


Koch’s Circuit 
Not Proven. 


An Air-borne 
Disease. 


A Matter of 
Precaution. 


Smallpox.” He described the germ of small¬ 
pox as a “protozoon,” representing the very 
lowest order of animal life and therefore quite 
different from the vegetable micro-organisms 
common to the majority of communicable dis¬ 
eases. Dr. Councilman is said to have proven 
that his germ will produce smallpox by his ex¬ 
periments on rabbits and monkeys, but as it is 
not produced by cultures Koch’s circuit is not 
traced. 

Smallpox is one of the air-borne diseases and 
enters the system through the respiratory tract 
and may also be introduced through the skin. The 
disease is so readily communicable that all dis¬ 
charges must at once be disinfected or burned. 
The chief factors in the spread of the disease are 
the secretions from the nose and throat and the 
desquamating skin, all of which contain the poi¬ 
son. Flies which alight on the patients spread 
the disease. Patients, must be protected by 
screens about their beds. Great care should be 
observed to prevent particles of peeling skin 
from being carried by the air as floating dust. In 
giving the baths the water should contain a disin¬ 
fectant. Antiseptic washes are used and also in¬ 
unctions of antiseptic ointments or oils to lessen 
the danger from desquamation. Formaldehyde 
vapor is recommended for fumigation after dis¬ 
infection at the close of the case. 

A lecturer* on “Specific Fevers” when speak¬ 
ing in the writer’s presence on the subject of 
smallpox a few years ago, advised a class of 

*Dr. Robert Saunders Henry, lecturer on Specific 
Fevers, Thomas Hospital, Charleston, West Virginia,, 
’98 to ’02.. 


64 



StJMMARY AND REVIEW. 


pupil nurses as a matter of precaution to “burn 
everything but the patient at the close of the 
case.” 

Preventive treatment in smallpox epidemics 
consists in the rigid carrying out of vaccination. 
It is not considered that a nurse who has been 
recently vaccinated incurs the slightest risk in 
nursing smallpox. 


SUMMARY OF CHAPTER V. 

The terms contagious and infectious as former-' 
ly used have given place to the more accurate 
term “communicable.” 

The specific invading micro-organism of some 
of the communicable diseases. 

Means of transmission—methods of entrance. 

Seat of invasion. 

Effects—constitutional or local. 

Multiplication or extermination of germs. 

Cleanliness and fresh air as preventives of dis¬ 
eases termed communicable. 

The points demanding most careful attention 
on the part of the nurse in all communicable dis¬ 
eases. Disinfection, etc. 


QUESTIONS FOR REVIEW CHAPTER V. 

I. —Give the nurse’s duties, especially as ap¬ 
plied to the severe forms of infectious diseases. 

II. —Give methods of entrance and means of 
communication in the diseases designated ; typhoid 
fever, diphtheria, scarlet fever, tetanus, tubercu¬ 
losis, smallpox. 

III. —What location is named as the seat of 

65 


The Nurse’s 
Danger. 






BACTERIOLOGY IN A NUTSHELL. 

invasion in typhoid fever? Describe the progress 
of the disease resulting in hemorrhage and per¬ 
foration. 

IV. —In which of the communicable diseases 
do you consider most rigid disinfectant and anti¬ 
septic precautions necessary? 

V. —Name some communicable diseases be¬ 
lieved to be due to impure water. 

VI. —Describe symptoms of tetanus. State the 
usual cause of the disease. How long after in¬ 
jury may danger of the attack exist? What 
treatment is recommended as preventive? 

VII. —What conditions are conducive to the 
development of tuberculosis ? Give method 
adopted as preventive of its spread. Name treat¬ 
ment most in favor and state the nurse’s duties. 

VIII. —How is the mosquito responsible for 
the spread of malaria? What effect has the dis¬ 
ease upon the blood of its victims? Are the par¬ 
asites long lived? In what manner do they mul¬ 
tiply ? 

IX. —Which are most susceptible to meningitis, 
old or young people. Why are the methods of 
cleanliness so rigidly carried out in other infec¬ 
tious diseases not recognized in meningitis? 

X. —What conditions favor the development 
of pneumonia? Show why constant vigilance in 
caring for a pneumonia patient is so necessary? 

XI. —To what means of communication is yel¬ 
low fever confined? What preventive measures 
are used? 

XII. —How does the germ of smallpox discov¬ 
ered by Councilman differ from those of other 
communicable*diseases? What essential part of 
Koch’s circuit is not carried out? 

66 


SUMMARY AND REVIEW. 

XIII. —Why should a strenuous use of disin¬ 
fectants be maintained in nursing smallpox? 
Name the principal preventive treatment. 

XIV. —Does the nurse incur greater risk in 
nursing smallpox than in nursing other severe 
forms of communicable diseases? 





6 7 


BACTERIA IN SURGERY. 


Germs 

Commonly- 

Encountered. 


CHAPTER VI. 


SEPSIS, ASEPSIS AND ANTISEPSIS. 

In surgical practice the bacteria met with most 
frequently are the following: 

The staphylococcus pyogenes aureus, the 
Streptococcus pyogenes, the bacilli coli com¬ 
munis, the bacillus tuberculosis and the bacil¬ 
lus tetani. 

The Staphylococcus *Pyogenes Aureus. 

Water, dust and air are all means by which this 
micro-organism is distributed. It is found, also, in 
the mouth, under the finger-nails, and in super¬ 
ficial layers of skin. This is the germ most fre¬ 
quently found to be concerned in severe forms of 
inflammation confined to small areas in which pus 
is found, described as “acute, suppurative circum¬ 
scribed inflammation.” While the staphylococcus 
pyogenes aureus does not form spores, it is very 
difficult to destroy, resisting to a remarkable de¬ 
gree all means used for its extermination. 

The Staphylococcus Pyogenes *Albus and 
*Citreus. These germs are found in the pus 

*Pyogenes signifies pus-forming. Aureus, golden-yel¬ 
low. 

Albus means white. 

Citreus, citron-yellow. These colors are assumed 
when seen in growing cultures. 

68 





SEPSIS—ASEPSIS—ANTISEPSIS. 

from acute abscesses, but are less virulent than 
the staphylococcus pyogenes aureus. 

Streptococcus Pyogenes. One of the most fre¬ 
quent causes of peritonitis after surgical opera¬ 
tions (post operative peritonitis) is said to be the 
germ streptococcus pyogenes. It is found also 
in puerperal endometritis (inflammation of the 
mucous membrane lining the uterus after a child 
is born) ; in ulcerative endocarditis (inflamma¬ 
tion of the membrane lining the heart accompa¬ 
nied by ulceration), and is also believed to be the 
cause of general septicaemia (general poisoning 
of the system due to bacteria in the blood). 

Diplococcus Pneumonia. This micro-organ¬ 
ism, or germ, is found in empyema (formation 
of pus in a cavity), and in acute abscesses. 

Bacillus Tetani. Surgeons always fear the 
bacillus of tetanus in accidental wounds, particu¬ 
larly those which have been exposed to danger 
of infection from the dust of streets, stables, or 
cellars. 

Sepsis, Asepsis and Antisepsis. Sepsis is 
the result of the gathering of bacteria into the 
blood. Bacteria, as we have already said in a 
previous chapter, is the name given by scientists 
to the large field or group of vegetable micro¬ 
organisms we commonly hear spoken of as 
“germs” or “microbes.” 

We have also said that there are special bac¬ 
teria for special diseases, as for example the “ba¬ 
cillus typhosus” in typhoid fever. In tuberculosis 
the “bacillus tuberculosis,” etc. The shape of the 
bacteria in many instances giving to it its name, 
viz.: bacillus, “rod-shaped or pencil-like,” spirilla, 
“twisted or curved,” cocci or micro-cocci, 
69 


The Cause 
of Sepsis. 


BACTERIOLOGY IN A NUTSHELL. 


Sepsis Should 
Not Occur. 


‘'sphere-shaped,” or like a ball or marble, with 
modifications or subdivisions of these shapes as 
for experimental purposes they are cultivated in 
broth or other liquid, and their varied methods of 
forming into groups is seen under the ^micro¬ 
scope. These varied groups are spoken of as 
“clusters,” “chains,” “twos,” “fours,” “eights,” 
and so forth. Sometimes the disease in which 
the germ is first found gives to it is name. The 
bacteria found in sepsis when seen under culti¬ 
vation are grouped in “chains,” and the name 
given to them is streptococcus pyogenes. 

Sepsis means poisonous or putrid. Asepsis, 
free from poison or putrefaction. Antisepsis, 
against poison or putrefaction. Sepsis is found 
in general surgery, in gynecological surgery 
and in obstetrics. But it ought not to be found 
in any one of them. In these days of aseptic 
surgery when so much time and thought and 
expense arc given to the preparation of the pa¬ 
tient, operating-room, dressings, surgeon’s 
gowns, caps, instruments, etc., so as to render all 
these, and surgeons, assistants and nurses as 
well, absolutely free from poison (aseptic) by 
the use of antiseptics no one should suffer from 
so terrible a condition, a condition dreaded by 
all physicians and nurses. 

Following the preparation of dressings, ban¬ 
dages, gauze, sponges, etc., the utmost possible 
vigilance is necessary in order to be sure that all 
are kept aseptic after they have been made 
aseptic. Of what avail is the special process 
they undergo if the packages containing them 
are opened and the dressings passed 

to the surgeon by a nurse or assist- 

70 


STERILIZATION AND DISINFECTION. 

ant who has not been properly prepared by the 
free use of soap, hot water, scrub-brush and the 
after thorough use of antiseptics, especially in 
“hand cleansing.” Of what use is it to use an 
aseptic brush, antiseptic solutions and so forth 
in preparing the area to be operated upon if the 
nurse who does the scrubbing and who uses the 
solutions has been opening and closing windows 
and doors, or touching other things not aseptic, 
and then comes to take part in the work men¬ 
tioned without first thoroughly scrubbing and 
sterilizing her hands? It is after just such blun¬ 
ders as these in operating rooms, or in private 
houses, that trouble with the patient often arises. 
There is great reason to wonder why trouble does 
not arise in every case carelessly handled. Fre¬ 
quently the patient comes through the operation 
well, and for a day or two seems to be doing 
nicely, then comes a chill, a sudden rise of tem¬ 
perature, an increased pulse rate, the patient is 
restless and uneasy, and has a worn, anxious 
expression ; other symptoms more or less alarm¬ 
ing appear. The physician is hastily summoned, 
and with a grave face, which he vainly tries to 
brighten in the patient’s presence, he examines 
the chart, then mutters beneath his breath “sep¬ 
sis;” always a dreajl word even to physicians and 
nurses grown old in the work. He removes the 
bandages and dressings to find abscesses formed 
about the stitches he had put in with such care, 
or, worse still, pus oozing from between the 
stitches. Then comes a hand to hand fight to 
overcome the effects of the poison and save hu¬ 
man life, which, sad to say, cannot always be 
7i 


Blunders 

During 

Operations. 


Result of 
Blunders. 


Bacteriology in a nutshell. 


Sepsis Cases 

Becoming 

Rare. 


The Debt We 
Owe Lister. 


accomplished, no matter how closely the physi¬ 
cian’s orders are carried out. 

In place of a surgical case we may have a case 
of ^obstetrics, perhaps a case in which it has been 
necessary to use instruments. The nurse in pre¬ 
paring them for the physician’s use has not been 
sufficiently careful, or in some other way some¬ 
thing containing the germs of disease has been 
carried into the puerperal genital tract. Again 
we have the characteristic symptoms observed in 
the surgical case, and again the dread word “sep¬ 
sis” rings in our ears. Glad we are to be able 
to say that such cases are more rarely encoun¬ 
tered as the years go by. A conscientious, well- 
trained nurse will watch every corner, and let no 
source of infection escape her keen eye. She will 
use all antiseptic precautions herself, and she will 
also guard well her work against any such dis¬ 
asters (or worse) as have already been alluded 
to. 

Surgeons, themselves, as a rule, realize very 
fully the grave responsibility of a life at stake; 
but seldom do we meet a careless one. They, as 
well as the world at large, owe a debt of grati¬ 
tude to Lord Lister for the discovery of the pos- 


*In some of the best Maternity Hospitals of the pres¬ 
ent day all personal clothing, as well as bed linen, used 
for both mother and infant during the first week are 
sterilized, just as for a surgical case. This applies 
especially to the gowns, abdominal bandages, perineal 
pads, diapers, etc. These are put up m packages, sep¬ 
arate from those containing gauze for the cord, silk, 
etc. Each package contains sufficient clothing for one 
day. After sterilization they are not handled until 
needed. Infants so cared for are said to be less trou¬ 
bled with skin eruptions, and there are no infections 
of the cord. Sterilization of articles used for the 
mother serves as a further protection against sepsis. 

72 



DISINFECTANTS-HOW MOST EFFECTIVE. 

sibility of the overthrow of the power of sepsis 
through the use of antiseptics. 

Sterilization and Disinfection. —We often 
hear the terms sterilization and disinfection used 
interchangeably as expressive of the same mean¬ 
ing, which, strictly speaking, is not accurate. 
When we sterilize anything we are supposed 
completely to destroy the vitality of all bacteria 
present, either within, or upon the substance 
sterilized. The process of sterilization is accom¬ 
plished by the proper application' for a stated 
period of either chemical agents or heat. 

In order to disinfect anything we do not neces¬ 
sarily destroy all the bacteria present, but only 
those that are harmful, because of their power to 
create disease-—power to infect, in other words. 

Certain substances used to prevent the growth 
of bacteria, but which may not necessarily destroy 
them, are called antiseptics. An antiseptic does 
not always possess the power to disinfect, but a 
disinfectant is always an antiseptic. 

Germicides and disinfectants are interchange¬ 
able terms because they both possess the power to 
destroy disease-producing germs. 

Deodorants are substances or agents used to 
destroy offensive odors; they are not of necessity 
disinfectants, but they may be. 

VARIOUS CONDITIONS MODIFY THE POWER OF DIS.- 
INFECTANTS. 

I.—The kind of bacteria we wish to destroy. 
Some are more difficult to kill or to render pow¬ 
erless to do mischief than others. Spores are 
found much harder to deal with, as was spoken 
of in describing their formation, than the bacteria 
from which they spring. 

73 


Sterilization. 


Disinfection. 


Antiseptics. 


Germicides. 


Deodorants. 


Conditions 
Modifying; the 
Power of 
Disinfectants, 


BACTERIOLOGY IN A NUTSHELL. 


An Assistant’s 
Mistake. 


II. —The number of bacteria to be destroyed. 
If a large number are present more of the solu¬ 
tion is necessary than for a small number. Com¬ 
pletely saturate the mass always, for whatever 
number. 

III. —The temperature and strength of the 
solution. Hot disinfectants are more effective 
than warm or cold disinfectants. 

IV. —Material with which a solution may come 
in contact. If some disinfectants come in contact 
with organic matter, they are rendered of little or 
no value thereby. The writer remembers seeing a 
pupil nurse sent three times to empty out and 
prepare anew a disinfectant solution because an 
assistant put his soiled finger into the first two, in 
order to test the temperature, and was about to 
make the same blunder a third time when pre¬ 
vented by the whispered admonition of the head 
nurse. The lesson is plain. 

Hot air, steam or boiling water, are all disin¬ 
fectants or germicides. The value of hot air or 
dry heat as a disinfectant is limited, as there are 
so many things which cannot be disinfected by 
either without being injured. Moist heat is more 
penetrating than hot air, and mattresses, clothing, 
and surgical instruments can all be treated by 
moist heat without sustaining injury. Clothing 
stained with pus, or fecal matter, should not be 
disinfected with steam heat, as the stains will be 
found difficult, if not impossible, to remove after¬ 
ward. 

Boiling water is warranted to destroy all 
known bacteria or their spores if exposed to its. 
power for a sufficient period. 

74 


ASEPTIC MEASURES. 


Intermittent Sterilization. By intermit¬ 
tent sterilization we mean the exposure of articles 
to be sterilized to the'action of live steam for one 
hour on three successive days. Certain spores 
are known to retain germinating powers after be¬ 
ing treated to a bath of boiling water, and the 
end sought in intermittent sterilization is to de¬ 
stroy all bacteria which may develop from spores 
after the first or second sterilization. The pro¬ 
cess is only rarely necessary, because exposure to 
live steam for one hour usually kills both bacteria 
and spores. 

In aseptic surgery many consider the use of 
both heat and chemicals necessary in order to in¬ 
sure freedom from all pathogenic bacteria and 
their spores. This applies only to the prepara¬ 
tion of dressings, sponges and the skin, except in 
diseased conditions. “Clean, healthy tissue con¬ 
tains no bacteria.” “Wounds in healthy tissue 
tend to heal spontaneously.” 

“Antiseptics being all more or less irritant tend 
to interfere with the healing process.” 

If a healthy wound is properly protected from 
possible invasion of micro-organisms, the use of 
antiseptics is unnecessary and may be injurious. 
Infection may reach the wound in several ways: 

I. —Because the room in which the operation 
is performed is not properly prepared,, or if 
sweeping or dusting is done just when the wound 
is to be uncovered for dressing. Dust must al¬ 
ways be wiped up in sick-rooms with a cloth 
wrung out of a disinfectant solution. 

II. —Use of water not sterilized, or not kept 
covered after sterilization, when it again becomes 
filled with micro-organisms. 

75 


Definition. 


Healthy 

Tissue 

Aseptic. 


Infection 

Healthy 

Wounds. 


of 


Never Dust 
With a Dry 
Cloth. 


BACTERIOLOGY IN A NUTSHELL. 


Responsibility 
of the Nurse. 


Precautions 

Used. 


Soak Hands 
and Arms. 


III. —If the skin of the patient has not been 
made aseptic prior to the operation. No matter 
how cleanly a person may .be, the skin, the hair 
follicles, and sweat glands all harbor bacteria, 
and if not properly attended to these may invade 
the wound. (Ordinary cleanliness is not “surgi¬ 
cal cleanliness.”) 

IV. —The hands of the surgeon or nurse may 
cause the trouble. 

V. —Instruments, drainage, the clothing of pa¬ 
tient, or operator or nurse, ligatures, sutures, 
sponges, dressings, towels, any of which may be 
infected. The nurse’s duty is to guard against 
danger of infection from whatever source. 

DISINFECTION AND DISINFECTANTS. 

No. i. Hand Disinfection. —Method used 
by Dr. E. Gustave Zinke, chief of staff and 
surgeon the German Hospital, Cincinnati, O., 
in disinfecting the hands. First, cleanse the 
hands (including the arms above the elbows) 
with plenty of antiseptic soap and hot 
water, using a sterile brush vigorously for 
ten minutes, especially for the nails, be¬ 
neath which germs lurk. Second, clean the 
nails thoroughly with a nail knife or file, to 
remove any bacteria the nail brush may have left 
behind. Third, wash the hands again, as the 
nail cleaning process may have deposited par¬ 
ticles of dirt containing germs on the hands. 
Fourth, soak the hands and arms for several 
minutes (2 to 3) in a solution containing about 
twenty grains potassium permanganate to each 
pint of water, and then in another solution of 
oxalic acid (saturated solution), soaking the 
hands for the same length of time. The po- 
76 


HANDS AND INSTRUMENTS, ETC. 

tassium permanganate is a good germicide, un¬ 
less it comes in contact with organic matter, and 
oxalic acid is a still better one; it also removes 
from the hands the brown stain of the potassium 
permanganate. Fifth , soak the hands and arms 
in alcohol, and again in hot' sterile water. The 
alcohol as a further precaution against bacteria, 
and the sterile water to relieve the irritation 
caused by the vigorous scrubbing and use of 
strong solutions. During operation Dr. Zinke 
uses alcohol, bichloride of mercury solution, i- 
8,000, and sterile water for further protection'. 

No. 2. Hand Disinfection. —Some surgeons 
use alcohol, followed by bichloride solution and 
hot sterile water, applied in the same way as 
the permanganate and oxalic acid are used after 
the vigorous scrubbing with brush, soap and 
water and use of nail knife recommended in No. 
i. There are various other methods of hand 
disinfection. 

No. 3. Hand Disinfection. —The method of 
hand cleansing and sterilization used by Dr. F. 
S. Thomas, chief of staff and surgeon of the 
Thomas Hospital, Charleston, West Virginia, is 
as follows: 

I. —Five to ten minutes thorough washing and 
scrubbing with green soap and hot water, using a 
sterile nail brush vigorously, especially about the 
finger nails, and drying with a sterile towel. 

II. —Careful cleaning and clipping of nails 
with nail file and knife. 

III. —A second washing of hands with soap 
and hot water for further cleansing from nail 
deposits. 


Alcohol and 

Bichloride 

Preferred. 


A West 
Virginia 
Surgeon’s 
Method (’g8-’o2). 


77 


BACTERIOLOGY IN A NUTSHELL. 


Thorough 

Cleansing 

Required. 


Watch Your 
Scalpels. 


Cover 

Instruments 

Quickly. 


IV. —Chloride of lime paste was next w'ell 
rubbed into hands and nails, and well rinsed off 
in a soda carbonate solution. 

V. —Soaking of hands two to three (2 to 3) 
minutes in a bichloride of mercury solution 
1-4000, followed by hot sterile water. 

During operation Dr. Thomas used frequently 
for his hands a bichloride of mercury solution 
1-4000, followed by sterile water as a precaution¬ 
ary measure. 

To Disinfect Surgeons' Scalpels and In¬ 
struments :—First, cleanse instruments and 
scalpels thoroughly, paying particular attention 
to all crevices and hollow parts. Wrap the blades 
of the scalpels in cotton and place in a separate 
tray above the tray in which you place the other 
instruments, as scalpels must only be boiled two 
minutes, to prevent dulling their edges. Place 
both trays in the sterilizer in which water is 
boiling (the water should contain a small quan¬ 
tity—2%—of carbonate of soda). Boil all instru¬ 
ments except scalpels or bistouries twenty min¬ 
utes. Remove from the sterilizer and place 
immediately in a five per cent (5%) solution of 
carbolic acid, covering the receptacle with a ster¬ 
ile towel, unless the surgeon prefers to use his 
instruments dry, which many do; in this case they 
are placed in a sterile receptacle and covered as 
quickly as possible. The same process of cleans¬ 
ing and .sterilizing should be adopted after an op¬ 
eration ; they must be wiped dry with a sterile in¬ 
strument cloth before returning to the instru¬ 
ment closet. 

The method of sterilizing instruments adopted 
by some hospitals is to wrap the instruments in 
78 


SPUTA, CLOTHING, BEDS, BEDDING, ETC. 

a sterile towel after cleansing thoroughly, and 
then exposing them to the influence of live steam 
for a stated period; about thirty minutes. 

To Disinfect Sputa and Sputa Cups:— 
Pour into the cups sufficient hot five per cent 
(5%) carbolic acid solution to saturate the con¬ 
tents of the cup. Add a small quantity of car¬ 
bonate of soda (common washing soda) to loosen 
the sputa from the sides and bottom of the cup; 
cover and allow to stand until cold before empty¬ 
ing. The cups should be well cleansed and 
boiled once a day in a soda-carbonate solution, 
particularly the sputa cups of tuberculosis pa¬ 
tients. 

To Disinfect Clothing, Beds, Bedding and 
Furniture: —Personal clothing, towels and bed 
linen used in the care of communicable diseases 
must be soaked for an hour or more in a proper 
disinfectant solution (carbolic acid, sol. five per 
cent (5%) is good), and then thoroughly 
washed. Dry in the outdoor air and sunshine. 
Mattresses and pillows should be exposed to the 
influence of live steam for a sufficient length of 
time to do good work. When there is no ap¬ 
paratus for the steaming process, wash the sur¬ 
faces of pillows and mattresses with the disin¬ 
fectant solution, turn over the foot-boards of the 
beds in rooms or wards to be fumigated, so that 
the substance used for fumigation may reach 
them from all sides. To complete the process, 
put them out in the fresh air and sunshine for 
twenty-four hours. Mattresses stained with ty¬ 
phoid fever defecations would better be burned. 

Beds, windows, walls, floors, woodwork and 
all pieces of furniture first must be cleansed with 
79 


Use of Soda 
Carbonate. 


Boil Sputa 
Cups. 


Out-door Air 
in Disinfection, 


Exposure 
from all 
Sides. 


BACTERIOLOGY IN A NUTSHELL. 


Leave Bureau 
and Other 
Drawers Open. 


Removal 
of Odors. 


Reversible 

Rubber 

Sheeting. 


soap and hot water and then washed with the dis¬ 
infectant solution. Bureau and stand drawers 
should be treated in a similar way, and left open 
for fumigation. If floor rugs are used they 
should be wiped off with the solution, and both 
sides exposed to the fumes of formaldehyde or 
other substance just as recommended for mat¬ 
tresses. Then they should be hung up and well 
beaten in the open air, and left there for twenty- 
four hours also. 

To Disinfect Rubber Sheets: —First, wash 
clean in hot water with soap and brush, rinse in 
clear water and soak one hour in carbolic acid 
five per cent (5%) solution, or other good solu¬ 
tion. Wipe dry and hang out in the fresh air 
and sunlight to remove any other odor than that 
of rubber. Sheeting with the rubber preparation 
on either side (reversible), is the best and safest 
in nursing communicable diseases. The disin¬ 
fecting can be more thoroughly accomplished, 
and the sheets look safe. This sheeting makes a 
good covering for all vessels used for evacua¬ 
tions, etc., to be disinfected. 


SUMMARY OF CHAPTER VI. 

Bacteria in surgery. Cases in which they are 
found. 

Sepsis, its cause, the germ found in sepsis. 
Why there should be no cases of sepsis in the 
present age. Why sepsis is so much to be 
dreaded. 

The “everlasting and eternal vigilance” neces¬ 
sary in surgical work and nursing. The dangers 
to be guarded against. What may come of blun¬ 
ders in surgery and in obstetrics. 

80 



SUMMARY AND REVIEW. 

Responsibility recognized by most surgeons as 
too great to be trifled with. 

The nurse’s responsibility should be ever up¬ 
permost in her thoughts. 

Sterilization. Disinfection. Antiseptics. Ger¬ 
micides. Deodorants. 

Conditions which may lessen the power of dis¬ 
infectants. 

Heat as a germicide. Intermittent steriliza¬ 
tion. 

Aseptic surgery. The precautions necessary to 
prevent infection from reaching healthy tissues. 


QUESTIONS FOR REVIEW-CHAPTER VI. 

I. —What germs are most commonly met with 
in surgery? What cases are they most likely to 
attack ? 

II. —What germ do physicians most fear in a 
certain class of accidental wounds? 

III. —Define sepsis, asepsis, antisepsis. What 
germ is said to be responsible for the disease 
sepsis ? How does it gain an entrance to the hu¬ 
man structure? Is it easily overcome? Describe 
the symptoms of sepsis. Seat of invasion in 
sepsis. 

IV. —Describe in detail the work of the nurse 
in guarding sources of infection before, during 
and after operations and in obstetrics. 

VII. —Define sterilization and disinfection. 
Antiseptics. Germicides. Deodorants. Are germi¬ 
cides and disinfectants interchangeable terms? 

VIII. —Give an accurate explanation of the 
conditions modifying the power of disinfectants. 

81 



BACTERIOLOGY IN A NUTSHELL. 

IX. —What do you know of intermittent ster¬ 
ilization? Explain where its use is advised. 

X. —Define aseptic surgery. What do many 
surgeons consider necessary adjuncts, to safety in 
the practice of aseptic surgery. Describe in de¬ 
tail the precautions you would observe in pro¬ 
tecting healthy wounds from infection. 


82 


Chapter VII. 


SOLUTIONS, THEIR USES AND PREPARATION. 


Carbolic Acid Solution as a Disinfectant : 
—Carbolic acid solution may be safely used for 
the disinfection of personal clothing, bedding, 
excreta, surgical instruments and appliances. It 
cannot be relied upon to destroy spores, and 
therefore should not be used as a disinfectant in 
tetanus, anthrax, malignant oedema, or in any 
disease due to invasion of spore-forming bacteria. 
A one per cent, strength solution is said to be 
sufficiently strong to destroy the germs of chol¬ 
era, typhoid fever, diphtheria and erysipelas if 
used hot in sufficient quantity, and allowed to 
stand an hour, so as to completely saturate the. 
material to be disinfected. 

A five per cent. (1-20) solution is necessary in 
surgical practice, in order to be reliable. Fifty- 
one drams of liquid carbolic acid dissolved in 
each gallon of water makes a five per cent, solu¬ 
tion. Pour boiling water over the carbolic acid 
and mix thoroughly. To make a small quantity 
of a five per cent (5%) sol. carbolic acid (1-20) 
add one dram of the liquid to nineteen drams of 
water. (See table at close of Chapter VII. for 
number of grains to each pint.) 

83 




BACTERIOLOGY IN A NUTSHELL. 

Bichloride of Mercury solution will destroy 
'all forms of bacteria and their spores. Strength 
1-500 required for spores—exposure one hour. 
Bichloride of mercury is not reliable for the dis¬ 
infection of excreta, because of its power to pre¬ 
cipitate an albuminous deposit, which forms a 
coating around the substance and prevents the 
solution from penetrating the mass. It is a good 
disinfectant for rooms, clothing or bedding. It 
ruins instruments or anything in the shape of 
metals. 

In making up bichloride of mercury solu¬ 
tions, tablets containing seven and a half grains 
are often used. One of these tablets added to 
one pint of water makes a 1-1000 solution. One 
to a quart a 1-2000 solution; 1-1000 is the strong¬ 
est solution used for almost any purpose. Water 
is added to obtain tile weaker solutions generally 
used. For example, if you have a quart of 
1-1000 solution prepared and the doctor asks 
for three quarts of 1-4000 solution, add three 
quarts of warm sterile water to your quart of 
I-1000 solution, and you will have the desired 
strength. If only a small quantity, say one pint 
of the solution 1-4000 is needed, take four 
ounces of the 1-1000 solution and add to it twelve 
ounces of water of the required temperature. 
In using the bichloride of mercury powder (cor¬ 
rosive sublimate), dissolve seven and one-fourth 
grains (grs. 7%) * n each pint of water. 

Sublamine, which is another preparation of 
mercury, called ethylenediamin-sulphate of mer¬ 
cury, is used for all purposes in which bichloride 
of mercury solutions are used. It is considered 
by some to be less irritating than bichloride of 
84 


SOLUTIONS—USES AND PREPARATION OF. 

mercury and alcohol to remove oily substances 
from the skin prior to its use as a disinfectant is 
unnecessary. Strength of solutions from i- 
10,000 up to 1-300. 

Peroxide of Hydrogen (Hydrogen Dioxide), 
also called “dioxygen,” is considered by many 
surgeons to have no equal either for safety or 
efficiency in treating cavities or surfaces secret¬ 
ing pus. This preparation must be kept tightly 
corked, as it evaporates rapidly, and in a cool, 
dark place; heat and light spoil the preparation. 

Intestinal Evacuations may be safely disin¬ 
fected by pouring upon them three times their 
quantity of boiling water. Cover and allow to 
get cold before disposing of them. Milk of lime 
made from freshly slaked lime is also a safe, 
cheap disinfectant for-excreta. It should remain 
in contact with the evacuation for several hours. 
Freshly slaked lime must be used in preparing 
this solution. To slake the lime, pour one pint 
of water over two pounds of lime. When dis¬ 
solved mix thoroughly. This preparation is also 
called “hydrate of lime.” To make the “milk of 
lime ,> solution, use one pound of hydrate of lime 
to eight pints of water. Contact with the air 
spoils this solution, renders it inert, and for this 
reason it should be made anew every two days. 

.Lysol is a good antiseptic, especially so as it is 
non-irritant. It can be used to disinfect almost 
everything in the sick-room. 

It is used also for irrigation purposes; for dis¬ 
infection of skin prior to operations; for hand 
disinfection, etc. Usually a two per cent, solu¬ 
tion is required. When using the liquid lysol a 
two per cent, solution can be made by dissolving 

85 


BACTERIOLOGY IN A NUTSHELL. 

two and one-half fluid ounces of the drug in 
one gallon of water. For dressings prior to 
operation, one-half per cent, solution is used. 
(For number of grains required in making up 
solutions, see table.) 

Creolin is another antiseptic used as a disin¬ 
fectant for the hands, and also for the purpose 
of irrigation. A five per cent, solution is suf¬ 
ficiently strong, as a rule. 

Potassium Permanganate is a fairly good 
disinfectant, but its application is limited, be¬ 
cause its action is so quickly rendered inert by 
contact with organic matter. It also stains a 
yellowish brown any object which it touches, and 
the stain requires the application of an acid to 
remove. It is used quite extensively as a deodor¬ 
ant in offensive wounds, for hand disinfection and 
to irrigate cavities. Sixteen to twenty grains of 
the potassium permanganate crystals to each pint 
of water is the strength of the solution gener¬ 
ally used. Oxalic acid (a saturated solution) is 
frequently used to remove the stain of potassium 
permanganate. It is considered to be a more 
powerful germicide than permanganate of potas¬ 
sium, but it is decidedly irritant in its effects. 

Normal Salt Solution is a very valuable 
antiseptic. As a douche and enema it is well 
known. It is also used in intravenous, subcu¬ 
taneous and rectal injections, for its stimulating 
effects after hemorrhage in various dis¬ 
eases; in shock during or after surgical opera¬ 
tions ; in toxemia from any cause. A pint of the 
solution is frequently given by rectal injection 
an hour or two before a surgical operation, as its 
use serves to lessen the possibility of shock, and 
86 


SOLUTIONS—USES AND PREPARATION OF. 

also assists in preventing the thirst from which 
patients so often suffer after surgical operations. 
0.7 per cent, is the strength used. The solu¬ 
tion is made by dissolving one dram of common 
salt in each pint of hot water. Sterilize in a 
covered vessel before using, except where used 
as a rectal injection, when sterilization is not 
necessary. When used intravenously, or sub¬ 
cutaneously, it must always be sterilized* The 
intravenous injections Tire never given by the 
nurse, as it is a method confined to the physician 
alone. It is used during operations very often, or 
immediately after operations, when there has 
been much loss of blood, or where the patient is 
suffering from shock, in order “to furnish suf¬ 
ficient fluid to suspend the remaining red blood 
cells for circulation through the system, and to 
restore a normal amount of circulating fluid for 
the heart and arteries to act upon.” 

When Preparing for an Operation the 
nurse can make up a salt splution containing two 
ounces of common salt to one pint of hot water; 
sterilize the solution by boiling five to ten min¬ 
utes, after filtering. Keep in a tightly closed ster¬ 
ile jar. One dram of this solution added to each 
pint of sterile water is the required strength for 
all injections necessary when the patient is suffer¬ 
ing from shock, exhaustion, or other causes in 
which normal salt is called for. It should be 
made anew for each operation. 

*Sterilize the syringe, canula, suture, thermometer 
for testing the temperature of the solution (which should 
be 115 0 to 120 0 F). scissors, and everything in the shape 
of instruments by boiling in soda carbonate solution. 
For the intravenous injections, thoroughly scrub and 
sterilize the area to be used. 

87 



BACTERIOLOGY IN A NUTSHELL. 

Formalin Solution. A four per cent, solu¬ 
tion of formalin is considered to be as effective 
as bichloride of mercury solution i-iooo, or as 
carbolic acid solution 1-20 ( 5 %). Formalin 

contains formaldehyde forty per cent, and wood- 
alcohol ten per cent. Unlike bichloride of mer¬ 
cury it does not deposit albuminous substances in 
solution, but it destroys iron, steel or other metal 
quite as effectually. The four per cent, solution 
is prepared by adding forty-one drams to each 
gallon of water. (For number of grains to use 
for each pint of solution see table at close of 
Chapter VII.) 

Boracic Acid is a mild, non-irritating antisep¬ 
tic used freely in irrigation and in surgery of 
the eye and ear. Many surgeons use a saturated 
solution; others prefer a solution of one dram 
to each pint of water. It is dissolved by pour¬ 
ing hot water over the acid powder. It does not 
dissolve readily in cold water. In fact it would 
better be boiled. In making the saturated solu¬ 
tion, it has been found that only about eighteen 
grains of the powder to each ounce of water is 
soluble in water alone. 

The American Standard. A solution known 
as the “American Standard” is made by dissolv¬ 
ing six ounces of chloride of lime in one gallon 
of water. It is said to be valuable in the disin¬ 
fection of excreta. Chloride of lime in order to 
be reliable must be purchased of a reliable man¬ 
ufacturer. 

Thiersch's Solution. In the preparation of 
this solution, which is often used as an antiseptic 
for purposes of irrigation, add one and a half 
ounces of boracic acid and two drams of salicylic 
88 


SOLUTIONS—USES AND PREPARATION OF. 

acid to one gallon of water. Dissolve the acids 
in hot water and sterilize before using. 

Balsam of Peru. A five to ten per cent, solu¬ 
tion of balsam of Peru is an antiseptic solution 
frequently used in dressing burns and other 
wounds. The balsam is combined with castor oil 
or glycerine as a base. Balsam of Peru, five per 
cent, and castor oil ninety-five per cent, is the 
common formula. 

These are a few of the best drugs for antisep¬ 
tic and disinfectant purposes now in use. New 
drugs for the same uses are being discovered 
every year. 

Sterile Water. As sterile water alone is so 
frequently used in aseptic surgery, its prep¬ 
aration should be understood even by nurses just 
entering the work. The water should first be 
filtered and then boiled in vessels* which have also 
been made thoroughly clean by washing and 
soaking in an antiseptic solution. Distilled water 
ought to be aseptic, but as those who distill it 
are apt to handle it carelessly, nurses are advised 
to boil even distilled water before using it for 
aseptic sugery. 


FILTERED WATER. 

Filtered Water is not considered safe to use 
for drinking or surgical purposes without steril¬ 
izing. The parasitic bacteria filter through any 
ordinary filtering apparatus, the process of filtra¬ 
tion only ridding the water of other impurities 
and making it transparent. A system of sand 

*Filtered water and salt solutions are preferably ster¬ 
ilized in their containers and kept therein tightly closed 
until used. 


89 



BACTERIOLOGY IN A NUTSHELL. 


filtration is in use in some cities. By means of 
the sand the parasitic bacteria are held in abey¬ 
ance until destroyed by the saprophytic. 

Alcohol is used in skin sterilization for the 
purpose of removing oily substances, which pre¬ 
vent the penetration of some other disinfectants. 
Ether is used for the same reason. 


SULPHUR FUMIGATION. 


To Fumigate 
With Sulphur. 


Danger from 
Inhaling. 


To use sulphur for fumigation, take about four 
pounds of rock sulphur (brimstone) for each 
one thousand cubic feet of space. All apertures 
and crevices about transoms, doors or windows, 
etc., must be well packed with damp absorbent 
cotton, or batting, or strips of old muslin, to pre¬ 
vent the escape of the gas. Paste paper over 
openings of grates or registers, key holes and 
speaking tubes. Place an agate-ware, or other 
metal basin or tub, half-filled with water upon a 
firm foundation made of several bricks built near 
the center of the apartment. Have the required 
amount of sulphur on top of some paper in an 
iron kettle sitting in the basin or tub of water. 
Pour over the sulphur a few ounces of alcohol. 
Set fire to the outer edge of the paper and leave 
the room quickly, as the fumes of gas from sul¬ 
phur are dangerous to many people.* Close and 
lock the door, and place a thick rug over any crev¬ 
ice that may be at the bottom. Keep the room 
closed for twenty-four hours, then open up the 
doors and windows and ventilate thoroughly. 

♦The writer remembers an instance in which a nurse 
was almost suffocated by inhaling sulphur gas. She 
thoughtlessly stepped back into the room for a forgotten 
article, and was almost overcome when rescued. 

90 






SULPHUR—FORMALDEHYDE—FORMALIN. 

Floors, woodwork, etc., should be again wiped 
over with a cloth wrung out of carbolic acid so¬ 
lution (5%) live per cent. 


FORMALDEHYDE FUMIGATION. 

Formaldehyde is more reliable for fumiga¬ 
tion than sulphur, and is less dangerous to in¬ 
spire. It is a gas made by burning methyl alco¬ 
hol, commonly called wood-alcohol, in a specially 
constructed lamp. One and a half pints of alco¬ 
hol are required for each one thousand cubic feet 
of air space. The process of converting this 
amount of alcohol into formaldehyde gas or 
vapor takes less than two hours, and the rooms 
or wards are ready for free ventilation at the 
expiration of eight hours. Observe the same 
method of packing crevices of doors, windows, 
transoms, etc., and of closing grate openings and 
key holes as described in sulphur fumigation. 

As so many formaldehyde lamps are unrelia¬ 
ble, some have found it more satisfactory to use 
formalin solution, which contains forty per cent, 
of formaldehyde. The formalin is boiled in a 
special apparatus and the gas passed into the 
room to be fumigated by means of a tube inserted 
through a key-hole or other small opening. One 
gallon of the preparation will supply sufficient 
gas to purify about twelve hundred cubic feet of 
air space. 


Advantages of 
Formaldehyde. 


Some Lamps 
Unsatisfactory. 


91 



BACTERIOLOGY IN A NUTSHELL. 


TABLE FOR PREPARATION OF SOLUTIONS. 
“From Hospital Formulary.” 

To Prepare One Pint of a Solution 
Required to contain of a certain substance. 

Take of the substance the 
below stated amount in 
Per cent. Or grains with enough 

water to make one pint. 

m 

(i l A) 
UH) 
(25*) 

(3) 
(3*0 
(4*0 
(714) 
(1450 
(i8K) 
(2414) 
(3654) 
(73) 
(97) 
(146) 
(180) 
(220) 
(290) 
(365) 
( 730 ) 
(1460) 
(1825) 
(3650) 

The following simple method of computing the 
amount of a liquid drug to be used may be found 
useful when preparing solutions for purposes in 
which absolute accuracy is not necessary. 

One pint, liquid measure, contains seventy-six 
hundred and eighty ( 7 , 680 ) minims—(g) 16 X 
(3) 8 X (m) 60 = (m) 7 , 680 —. 

Multiply the number of minims by the per 
cent solution required and the result gained will 
be the amount of drug in minims for each pint 
of solution. Divide this sum by sixty ( 60 ), the 

92 


1/100 

per 

cent.. 

. .1 

in 

10,000. .. 

.grains 

0-73 

1/50 

per 

cent.. 

. .1 

in 

5,000. .. 

.grains 

1.46 

1/40 

per 

cent.. 

. .1 

in 

4,000... 

.grains 

1.83 

1/30 

per 

cent.. 

. .1 

in 

3,000... 

.grains 

2-44 

1/25 

per 

cent.. 

. .1 

in 

2,500... 

.grains 

2.92 

1/20 

per 

cent.. 

.. 1 

in 

2,000. .. 

.grains 

3-65 

I/I 5 

per 

cent.. 

. .1 

in 

1,500... 

.grains 

4.87 

1/10 

per 

cent.. 

. .1 

in 

1,000... 

.grains 

7-30 

1/5 

per 

cent.. 

. .1 

in 

500... 

.grains 

14.60 

1/4 

per 

cent.. 

. .1 

in 

400... 

.grains 

18.25 

1/3 

per 

cent.. 

. .1 

in 

300... 

.grains 

24-33 

1/2 

per 

cent.. 

. .1 

in 

200... 

.grains 

36.50 

I 

per 

cent.. 

. .1 

in 

100... 

.grains 

73-00 

I 1/3 

per 

cent.. 

.. 1 

in 

75 ... 

.grains 

97-33 

2 

per 

cent.. 

. .1 

in 

50 ... 

.grains 

146.00 

254 

per 

cent.. 

. .1 

in 

40. .. 

.grains 

182.50 

3 

per 

cent.. 

. .1 

in 

33 %. 

.grains 

219.22 

4 

per 

cent.. 

. .1 

in 

25... 

.grains 

292.00 

* 5 

per 

cent.. 

. .1 

in 

20... 

.grains 

36500 

10 

per 

cent.. 

. .1 

in 

10... 

.grains 

730.00 

20 

per 

cent.. 

. .1 

in 

5 -.- 

.grains 

1460.00 

25 

per 

cent.. 

. .1 

in 

4... 

.grains 

1825.00 

50 

per 

cent.. 

. .1 

in 

2... 

.grains 3650.00 



SUMMARY AND REVIEW. 

number of minims in a dram, and you will have 
the quantity to be used in drams. 

Example .—To make one pint (OI) of a five 
per cent solution: 

7680 X *05 =384.00-^60=6.40, or about six 
and a quarter (6 1-4) drams of the drug to each 
pint of water. 

For a two per cent solution proceed as before: 
7680 X .02=153.60-^60=2.56, or about two 
and a half (2^) drams to each pint of water. 

SUMMARY OF CHAPTER VII. 

Carbolic Acid Solution—its value as a disin¬ 
fectant. Its preparation and uses. Its uncer¬ 
tainty in destroying spores. 

Bichloride of Mercury Solution—preparation 
and uses. Its power to precipitate albuminous 
deposits. 

Use and care of Peroxide of Hydrogen. 

Safe method of disinfecting excreta. The prep¬ 
aration of lime for such purposes. 

Lysol and Creolin as safe antiseptics. 

Advantages and disadvantages of Potassium 
Permanganate as a disinfectant. Oxalic Acid 
in comparison. 

Value of Normal Salt Solution. Its prepara¬ 
tion, when and how used. 

How Formalin may be as effective as bichlo¬ 
ride of mercury, or carbolic acid. 

Boracic Acid, mild, non-irritating, much used 
for the purpose of irrigation. 

American Standard and Thiersch's Solution— 
their composition and uses. 

Balsam of Peru combined with an oil one of 
the best dressings for burns. 

93 



BACTERIOLOGY IN A NUTSHELL. 


Sterile Water—process of sterilization. Dis¬ 
tilled water. Filtered water not used without 
sterilizing in aseptic surgery. 

QUESTIONS FOR REVIEW. 

I. —Is carbolic acid a complete germicide? In 
what class of diseases is it safest to employ other 
disinfectants rather than carbolic acid? 

State accurately how to prepare a carbolic acid 
solution suitable for use in surgical practice. 

II. —Why is bichloride of mercury unsafe to 
use for disinfecting excreta? Surgical instru¬ 
ments? Haw would you prepare one pint of bi¬ 
chloride of mercury solution 1-4000 from a solu¬ 
tion 1-1000 as a base? 

III. —What can you say of the efficiency of 
peroxide of hydrogen ? What precautions should 
be taken to prevent its becoming inert? 

IV. —What can you say of the value of lime 
as a disinfectant? Iiow would you prepare it for 
use? 

V. —Name several points in favor of the use 
of lysol as an antiseptic. Also mention one or 
two disadvantages of potassium permanganate. 

VI. —In what ways does the use of normal salt 
solution benefit the patient when used during or 
after operation? 

VII. —What advantage has formalin solution 
over bichloride ..of mercury for disinfecting ex¬ 
creta? 

VIII. —Why is the free use of boracic acid 
safe? 

IX. —Flow is the “American Standard” solu¬ 
tion prepared? Also “Thiersch's Solution?” 

94 


REVIEW. 


What per cent, solutions of the balsam of Peru 
are used? Mention a common base. 

X. —Describe the method of sterilizing water. 
Is it safe to sterilize water without filtering? And 
is distilled water safe to use in aseptic surgery 
without sterilizing? 

XI. —Describe the process of sulphur fumiga¬ 
tion. What are its disadvantages? 

XII. —What is formaldehyde? State why it 
is a more reliable substance to use for fumiga¬ 
tion than sulphur. Has its use any disadvan¬ 
tages ? 


95 


HYGIENE. 


Chapter VIII. 


Result of 
Neglected 
Hygienic Laws. 

Neglect of the laws of hygiene frequently 
brings upon the human structure troubles which 
so weaken its various organs and systems that 
access and development of bacteria therein be¬ 
comes an easy matter. It seems opportune, there¬ 
fore, to add a few thoughts along hygienic lines. 

Nurses, perhaps more than any other class of 
women, should not only understand but obey the 
laws of Nature as revealed to us in the study of 
hygiene. We are so often questioned by sick ones 
entrusted to our care as to why certain ills have 
come into their lives. Too often they suffer from 
diseases brought upon themselves through neg¬ 
lect or ignorance of hygienic laws. While it is 
* not within the province of the nurse to take the 
place of the physician, whose duty it is to ex¬ 
plain this painful truth to his patient, she can 
very often afterward help the sufferer by sug¬ 
gestion, advice and example, to guard against 
future troubles. 

Hygiene 

Defined. 

In the first place, then, what do we mean by 
hygiene? Hygiene is that branch of science 
which teaches us how to keep healthy. In by¬ 
gone years, so-called civilization and the accom¬ 
panying customs of the day laid so many restric- 
96 


HYGIENIC SUGGESTIONS. 


tions upon women that it was impossible to fol¬ 
low fashion’s dictates and be healthy at one and 
the same time. Young girls were put into tight 
corsets, French-heeled shoes, etc., when scarcely 
beyond Dabyhood; at any rate, before they were 
fairly in their teens and while they should still 
have been at play, a thing quite out of the ques¬ 
tion for the poor little martyrs arrayed in such 
outlandish costumes. In fact, at the time when 
foolish mothers allowed themselves to follow 
fashion’s whims and so torture their young 
daughters, for half-grown girls to romp and 
play games was considered a social outrage and 
it young women were to attempt to join in out¬ 
door sports the offense was rated about next door 
neighbor to criminal. While there may be, and 
probably are, many who still cling to such erron¬ 
eous and silly notions, the day has pretty well 
gone by when established fashions are so directly 
opposed to the laws of health. Woman nowa¬ 
days has just as good opportunities to be healthy 
as has her brother man. In this age young girls 
and young women may join with members of 
the ''sterner sex” in games of tennis, golf and 
croquet without being considered “Tom-boys” 
or unladylike. They learn to swim and to row. 
to climb to the hilltops, to ride horseback, to take 
calisthenic exercises, to go corsetless if they want 
to, and to wear skirts whose trains are not an 
impediment to long, brisk walks in God’s pure 
air and sunshine, all without danger of being 
called or thought of as either immodest or ahead 
of the age, and therefore objects for contempt. 

In our work as nurses so much of our every¬ 
day duty lies within doors that we are apt to 
97 


Dame Fashion 
and Hygiene. 


Society’s 

Restrictions. 


Out-door 
Games No 
Longer 
Tabooed. 


BACTERIOLOGY IN A NUTSHELL. 

become careless or forgetful of the laws which 
keep us healthy, the principal and most important 
ones of which are the daily bath, fresh out-of- 
door air and sunshine and exercise, also sufficient 
rest and sleep and proper food taken at regular 
intervals. Without obedience to these laws at 
the right time and in the right way the nurse 
cannot satisfactorily fulfill her duty to those the 
physician entrusts to her care. If she attempts it 
she soon becomes a physical or mental wreck, 
TT . , sometimes both. The average length of time the 

Length of Days, conscientious nurse is able to remain in active 
service ias care-taker of the sick is said to be 
about ten years. The time must of necessity be 
much shorter if her health is neglected. This 
does not by any means signify that we may ever 
^ A , shirk dutv. Oh, no! There are frequentlv times 

Our Neighbor. of emergency when the nurse, especially the nurse 
in private work, finds it impossible to have her 
hours “off duty.” So often there is no one in 
the home who is sufficiently experienced in the 
care of the sick to be trusted to relieve her 
even for a few hours of much needed rest. If 
the expense of a second trained nurse cannot be 
afforded, then the path of duty is obvious. These 
hours of danger, as a rule, do not last through 
many days. Then we must again take up oitr 
“sponge” and “plunge” baths, our brisk walks in 
the fresh air and sunshine more rigorously than 
ever, and so regain our lost tone. 

Let us decide right in the beginning as we 
enter nursing ranks to divide our time of recrea¬ 
tion in cultivating all the aids to health and use¬ 
fulness (not neglecting the mind), and so pro¬ 
long the “length of days” we shall spend in pur- 
98 


HYGIENIC SUGGESTIONS. 

suit of our high and noble calling. High and 
noble indeed to those who enter the work in the 
right spirit. Not for the sake alone of the money 
in it,* although the financial side of the question 
is important, “surely the laborer is worthy of 
his hire,” and be assured that to the “worthy” are 
always given the fruits of their labor with all 
kindly appreciation. But let us remember, also, 
that there is an inborn love of the work para¬ 
mount in the heart of every nurse who ever be¬ 
comes in any true sense of the word worthy and 
a success. Such nurses enter the training-school 
with heart and soul and mind aglow, with hands 
ready and willing accurately to perform the most 
trivial or the most difficult tasks with equal care 
and promptness. These are the nurses who de¬ 
spise gossip, scorn deceit and all petty meanness, 
and who realize that personal responsibility is at¬ 
tached as a primary link in the chain of “qualifi¬ 
cations of the good nurse.” This realization 
keeps them ever on the alert to add to this pri¬ 
mary link all the others necessary to make them 
not only good nurses but the best nurses pos¬ 
sible. 

While realizing our duty towards others, do 
not let us forget that we owe a duty to-ourselves 
also; that we are responsible to God for our 
own health. There are broken-down nurses in 
the world to-day who ought still to be in active 

*The writer once had the misfortune to hear a pupil 
nurse, who had been rebuked for neglect of duty, make 
this remark: “I don’t care how I get through my work 
in training school. What I am thinking of is the $20 a 
week I am going to make when I am out for myself.” 
Girls, do not enter the field in such a spirit! The place 
for such nurses is outside the ranks with the nurses 
who cannot control temper. 

99 


The Successful 
Nurses. 


Our Duty 
to Ourselves. 



X 


V 


Nature’s 

Gifts. 


Results of 
Inactivity. 


Results of 
Overwork. 


BACTERIOLOGY IN A NUTSHELL. 

service, but whose condition, through mistaken 
ideas of duty, renders them a burden to them¬ 
selves and to others. 

A Healthy Muscular System. —We are 
taught when studying the muscular system that 
Nature gives to each individual about the same 
kind and amount of muscle; that the difference 
in strength as seen in different people is due in 
part to the manner in which they are taken care 
of, used, disused or abused. All of our organs 
must have proper exercise in order to be kept 
healthy, and in order also that we get from them 
that service for which they were intended. 

If we do not use our brains in study while we 
are young they become inactive and we grow dull 
and stupid. In later life we awaken to the fact 
that there are a great many things we would 
like to know which we do not know, and we find 
it a much more difficult task to get our brains 
to act as we desire them to than it used to be. 
Study then becomes a burden rather than a pleas¬ 
ure. In the same way, if we do not exercise the 
voluntary muscles (those muscles which our will 
controls) sufficiently, they become wasted and 
soft and flabby, and we feel the effects of their 
disuse in the involuntary muscles (those muscles 
over which our will has not control). The heart 
does not do its best work, the organs of respira¬ 
tion and of digestion and of excretion are im¬ 
paired, and the whole structure is apt to suffer. 

On the other hand, if the voluntary mdscles 
are abused by over-exercise and insufficient rest 
we have other evils to contend against. They 
wear out faster than Nature can supply the new- 
material with which to rebuild them, and we have 
100 



HYGIENIC SUGGESTIONS. 

again the weak, flabby voluntary muscles, and 
suffering to endure also from a weakened con¬ 
dition of the involuntary. 

Exercise. —Proper muscular exercise then is 
necessary if we preserve our health. Muscular 
development of the arms is often very noticeable 
in nurses who gi\e massage treatment. Good, 
brisk walks in the open air are conducive to the 
development of all the muscles of the human 
structure. When walking do not drag along as 
if not quite sure what your limbs were given you 
for. It is necessary to walk briskly in order to 
keep the circulation just right. Keep your head 
erect; your shoulders well thrown back to give 
the inspired air a chance to expand the lungs 
and keep them in good working trim. Narrow- 
chested people become such very often because 
they neglect to carry themselves erect and 
“square their shoulders’’ when they stand or 
walk. Narrow-chested people court tuberculosis. 
To walk several miles a day is necessary for those 
whose occupations keep them indoors most of the 
time. 

Dress. —There is nothing more hygienic in the 
way of dress than the nurses’ uniform, but it 
was never designed for street wear. It was de¬ 
signed to protect the sick from bacteria so fre¬ 
quently carried to them in the woolen dresses, as 
well as by the soiled hands, of those who used to 
care^or them, and who knew nothing of the 
laws^of hygiene as trained nurses understand 
them to-day. 

In some cities nurses seem to be given to the 
habit of going about the streets and on street 
cars in their uniforms when out for a “constitu- 

IOI 


Walking 
Develops the 
Muscles. 


How to 
Walk. 


How to 
Dress. 


Keep the 
Uniform 
Sacred. 


BACTERIOLOGY IN A NUTSHELL. 


Dress 

Sensibly. 


The Various 
Baths. 


tional.” This practice, if they but stop to think 
about it, must impress them as all wrong. We 
can never tell just where we may encounter a 
communicable disease, just as likely on the street 
cars as anywhere else. How dreadful to carry 
its germs back to some poor sufferer with al¬ 
ready enough to bear! Let our uniform then be 
sacred to the sick-room alone, but let us always 
wear it there. 

Have a street dress which is simply but taste¬ 
fully made and quickly donned. Wear hygienic 
waists, and skirts suspended from the shoulders 
rather than from the hips. Wear sensible-look¬ 
ing, neat hats. Nothing is much more un¬ 
professional than a nurse in a hat on the “flower 
garden” order, or who is adorned with neck 
chains, rings, “bangle” bracelets, and so forth, 
whose skirts sweep the streets and gather up 
dust and bacteria as they sweep. When it 
comes to exercising in garments that constrict 
the chest and abdominal muscles, it is quite out 
of the question. How can the abdominal or pel¬ 
vic organs remain healthy when thrown into 
unnatural positions by pressure of tight cor¬ 
sets, waist bands or dragging skirts? It is the 
nurse’s duty Jto dress so as to be healthy. Her 
work demands health. There is no room in the 
ranks for the nurse who (f enjoys poor health 

Let us all try to be healthy. 

The Bath. —Nothing is more conducive to 
good vigorous health than proper and systematic 
bathing. Few things are more restful to the 
tired nurse when she comes off duty than a good 
warm salt bath before retiring. A pint of sea salt, 
or common salt, to each two gallons of water 
102 


HYGIENIC SUGGESTIONS. 

is a fair proportion. Take a good “rub’’ with 
a Turkish towel on emerging from the bath. A 
cold sponge bath should be taken in the morning 
when you rise. Many recommend a cold “plunge” 
bath and find it very healthful when taken quickly 
and followed by a brisk rubbing, but it is a bath 
not suited to all constitutions. Those who find a 
coid plunge too severe, often enjoy getting into 
a tepid bath and gradually lowering the temper¬ 
ature until it is cold. A good soap and water tub 
bath several times a week seems necessary to 
healthful conditions, in addition to “salt” baths, 

“sponges” and “plunges.” When taking a bath 
after a meal, allow two hours to elapse before be¬ 
ginning operations. 

The Hair, the Teeth, the Nails, Etc.— Disinfect the 
Take care of your hair and keep it well sham- Hair, 
pooed. Diseases can be communicated from one 
to another by bacteria which fasten upon the 
hair, as well as upon the skin, beneath the finger 
nails and within the mouth. Do not forget these 
points when carrying out personal disinfection at 
the close of nursing a communicable disease. 

The toilet is never complete until the hair, the 
teeth and the finger nails are as immaculate as 
the dress and the rest of the person. 

Do not forget that neglect of Nature’s calls 
leads to habitual constipation, cystitis and other obey the 
evils allied to these. Write this truth in capitals Calls of 
upon your memories. It will save you lots of 
trouble. 

Food and Water Supply. —In order to keep 
healthy, food should not only be taken at regular 
intervals and in proper quantities, but it should 
also be of the most nutritious, easily digested 
103 


BACTERIOLOGY IN A NUTSHELL. 


A Mixed Diet. 


Water Supply. 


Ventilate Your 
Sleeping Rooms. 


and assimilated character. Pastry and sweets 
should be partaken of very moderately, if at all. 
The heaviest meal of the day should not come in 
the evening when the digestive system is tired 
from the exertions of the day and needs rest. 
A mixed diet, consisting of meat, vegetables, 
fruit, bread, eggs and milk, will be found more 
valuable, when planning for a healthful diet, than 
the cranky idea of living entirely upon vegetables 
or going to the other extreme and cutting them 
out of the food list entirely. 

Do not drink cold water, particularly ice-cold 
water, with your meals. It chills the stomach 
and retards digestion. The human structure re¬ 
quires plenty of water to keep the wheels of its 
complex machinery in good running order, but 
this water supply should be taken in between 
meals and should be as pure as filtering and boil¬ 
ing will make it. Put the pitcher containing the 
water on the ice instead of putting ice into the 
pitcher. Few germs, if any, are entirely de¬ 
stroyed by freezing. They usually thaw out and 
renew their activities. 

Rest and Sleep. —Do not sleep or rest in a 
stuffy, dusty, badly ventilated room. Remember 
to have between two and three thousand cubic 
feet of fresh air in all sleeping rooms and espe¬ 
cially in sick-rooms. This amount of air we have 
already said, when speaking of “communicable 
diseases,” is found in a room twenty feet long by 
fifteen feet wide with a ceiling elevation of ten 
feet, provided the current of air is changed fre-; 
quently to keep it pure. The windows should al¬ 
ways be open at the top and to aid in the regular 
changing of impure for pure air, open them up 
104 


HYGIENIC SUGGESTIONS. 


from the bottom for a while every day and open 
the doors also. Do not rest or sleep in a current 
of air. It is an injurious habit for even the most 
vigorous. 

Do not sleep in any garment worn during the 
day. Learn to relax the muscles when resting. 
Do not sleep with a pile of pillows beneath the 
head; use only a small pillow. Better no pillow 
at all than to be held up in almost a sitting posi¬ 
tion all night, rounding the shoulders and mak¬ 
ing the chest hollow. 

Keep your own room clean and neat. It is a 
matter quite surprising to find any number of 
nurses whose rooms look as if “a cyclone had 
struck them,” and yet who would not be guilty 
of such negligence if they were more thoughtful 
of laws of health as applied personally. 

Sunshine.— Sleeping rooms and all rooms oc¬ 
cupied by the delicate should be rooms with a 
southern exposure, so as to have the effects of 
the sun’s rays for the greater part of the day. 
Not only should we live in the sunshine as much 
as possible, but we should ourselves be sunny. 
The only place for the gloomy nurse is with the 
mercenary nurse and the nurse who “enjoys 
poor health”—outside the ranks. This thought 
is particularly applicable to those nurses who hon¬ 
estly desire to be successful. Those with a sunny 
disposition are always at a premium. What sick 
one can fail to love and desire to have about her 
the nurse with a “southern exposure.” She 
fairly beams as she enters the sick-room, and no 
matter how plain her face this nurse always 
looks beautiful in the eyes of the sufferer, to 
whom she invariably seems to communicate sun- 
105 


Remove 
Day Garments. 


Let the 
Sunshine In. 


The Sunny 
Nurse. 


BACTERIOLOGY IN A NUTSHELL. 

shine, the power of which dissolves and drives 
away all gloomy forebodings. She cannot fail 
to cure the “blues,” for the sorriest grumbler in 
the “slough of despond” on the sick-list must 
needs feel ashamed of such moods in the presence 
of the sunny nurse. 

Let us all learn to let the sunshine into our 
hearts as well as to let it shine upon us. “Let 
the sunshine in” and it will radiate from the eyes 
and the smile of the good nurse; be felt in the 
touch of her gentle, kindly hand, and in the tones 
of her cheerful, hope-inspiring voice. 

It is not only the blessed privilege of each 
nurse to be the best nurse possible and to be all 
that is truest, purest and most perfect among 
women, but it is also her duty. So shall every 
nurse be beloved and in being beloved do her 
best and noblest work. 

“The world may sound no trumpet, 

Ring no bells, the Book of Life 
The shining record tells.” 

SUMMARY OF CHAPTER VIII. 

Ills brought upon the human structure by neg¬ 
lect of hygienic laws. 

Fashions of bygone days opposed to laws of 
health. 

Restrictions of society with regard to games, 
dress, and so forth, a thing of the past. 

Forgetfulness on the part of the nurse with 
regard to hygiene may be the cause of a short¬ 
ened period of usefulness. Following its pre¬ 
cepts may lengthen the period. 

How success is obtained by the good nurse. 

Walking and dressing sensibly. The sensible 
dress the hygienic dress. 

106 


SUMMARY AND REVIEW. 

Keeping the uniform sacred to the sick-room, 
and why. 

Bathing and when to bathe so as to be healthy. 
The care of the hair, the teeth and attention to 
Nature’s calls. 

Proper diet and sufficient water supply neces¬ 
sary to health. 

Ventilation. Fresh air, sunshine and a sunny 
disposition and their effects. 

QUESTIONS FOR REVIEW. 

* 

I. —What is hygiene? 

II. —Why is it necessary to both study and 
practice the teachings of hygiene? 

III. —How does manner of dress infringe upon 
laws of health ? 

IV. —Why should outdoor sports and exercise 
be encouraged? 

V. —Is the nurse responsible for the care of 
her own health as well as that of her patient? 

VI. —Is she often excusable for neglecting out¬ 
door exercise, baths, hours of sleep, Nature’s 
calls ? 

VII. —Why should a mixed diet which is nu¬ 
tritious, easily assimilated and digested be ad¬ 
hered to? 

VIII. -—Explain why fresh air, sunshine and 
clean, well-ventilated apartments are necessary to 
health. 

IX. —Is the nurse who does not try to keep 

107 


BACTERIOLOGY IN A NUTSHELL. 


healthy just as much out of place in the nursing: 
world as the nurse who does not try to control 
her temper? Give reasons for your answer. 

X.—Why should a nurse above all other 
women aspire to be one of its purest, brightest 
and noblest types? 



108 


INDEX. 

A. 

Acid, boracic, 88. 

“ carbolic, 14 , 83 . 

“ oxalic, 76 , 86. 

Air, 47 , 51 , 57 , 104 . 

Alcohol, 90 . 

American Standard, 88. 
Ammonia, 23 . 

Animal life, 22 , 23 . 

Animals, domestic, 52 . 
Antisepsis, 69 - 70 . 

Antiseptics, 72 . 

Antitoxins, 37 - 39 . 

Asepsis, 69 - 70 , 75 . 

Assistant, 70 . 

mistake of, 74 . 


B. 

Bacilli, definition of, 27 . 

Bacillus, cholera, 15 . 

“ diphtheriae, 16 , 50 . 
of Friedlander, 15 . 
of leprosy, 14 . 
of pestis, 63 . 
tuberculosis, 15 , 56 . 
tetani, 16 , 53 . 
typhosus, 14 , 42 . 
yellow fever, 16 . 

Bacteria, classification, 27 . 

“ coloring, 29 . 

definition, 22. 
destruction, 29 , 30 , 37 . 
in the diseased, 21 , 30 . 

“ “ healthy, 29 - 30 . 

“ natural processes, 23 - 24 . 
most important, 27 . 
movement, 49 . 
multiplication, 30 - 31 . 
parasitic, 22. 

“ saprophytic, 22. 

size of, 28 . 
transparency, 29 . 

109 


BACTERIOLOGY IN A NUTSHELL. 


Bathing, 102. 

Bichloride of mercury, 84. 

Brains, 100. 

Bread, 104. 

Bubonic, plague, 63. 

C. 

Capsule, 31. 

Carbon, 23. 

Carbonic acid gas, 24. 

Carbon dioxide, 24. 

Cells, 20-21. 

Cerebro-spinal meningitis, 59. 

Cholera, 49. 

Cleanliness, 47, 58, 105. 

Communicable diseases, 42-67. 

“ ' “ channels of entrance, 36. 

“ methods of communication, 44-64 
“ “ nursing in, 42-66. 

Compound microscope, 10. 

Contents, 3-4. 

Councilman, 16, 63. 

Creolin, 86. 

Croup, membraneous, 51. 

Cultures, 27, 28, 37, 49, 64, 70. 

D. 

Dairy, the, 45. 

Dairies, (note), 44. 

Decay, trees and plants, 23. 

“ animals, 24. 

Deodorants, 72. 

Desquamation, 52, 55, 64. 

Devaine, 12. 

Diet, 57, 103. 

Dioxygen, 85. 

Diphtheria, 16, 50. 

Diplococci, 28. 

Diplococcus lanceolatus, 15, 60, 69. 

Disease, definition, 21. 

Disinfectants, conditions modify, 73. 

Disinfection, 72-80. 

Dress, 101. 

Dysentery, 34, 49. 

E. 

Eberth, 14, 42. 

Epidemics, 45, 50, 51, 60, 62, 63. 

Erysipelas, 55. 


IIO 



BACTERIOLOGY IN A NUTSHELL. 

F. 


Fever, 14. 

“ bathing in (note), 48. 
relapsing, 61. 
specific (note), 64. 

“ scarlet, 52. 

“ typhoid, 48. 

“ yellow, 62. 

Filariasis, 62. 

Fission, 30. 

Flies, 44, 63, 64. 
Formaldehyde, 88, 91. 

lamps, 91 
Formalin, 88, 91. 

Fraenkel, 15, 60. 

Friedlander, 15. 

Fruit, 45, 104. 

Fumigation, 90. 


G. 

German measles (Roseola), 52. 
Germicides, 73. 

Gonorrhoea, 14. 

H. 

Hemorrhage, 43, 86. 

Hair, the, 76, 103. 

Hanson, 14. 

Health, 96. 

Healthy exercise, 101. 

“ games, 97. 

“ muscle, 100. 

Henle, 11. 

Hoffman, 22. 

Hydrogen peroxide, 85. 

dioxide, 85. 

Hygiene, 96-108. 

“ defined, 96. 

“ neglected, 96. 

“ personal, 46. 

Hygienic dress, 101-102. 

I. 

Ice water, 104. 

Immunity, 37. 

Incubation, 36. 

Influenza, 51. 

Inoculation, 12, 35, 38, 39. 
Introductory, 5, 6. 


II 


.BACTERIOLOGY IN A NUTSHELL. 

K. 

Klebs, 13. 

Koch, 14, 15, 16, 39, 42, 49. 

L. 

La grippe, 16, 51. 

Leeuwenhoek, 9-11. 

Lens, single, 9. 

Leprosy, 14. 

Lesion, 35. 

Lister, Sir Joseph, 14. 

Loeffler, 16. 

Lysol, 85. 

M. 

Malaria, 58. 

Malariae, plasmodium, 58. 

Maternity, hospitals, (note) 72. 

Measles, 52. 

Meat, 45, 104. 

Meningitis, 59. 

_Metschnikoff, 29. 

Micrococci, 27. 

Micro-organisms, 22. 

Milk, 44, 104. 

Morphology, 27. 

Mosquitoes, 58, 62. 

Mumps, 52. 

N. 

Nails, the, 103. 

Nature’s gifts, 100. 

. Neisser, 14. 

Nicolaier, 16. 

Nitrogen, 23. 

Normal salt sol., 86. 

“ “ “ some uses of, 87. 

Nurse, the bad tempered, 99. 

“ “ good, 99. 

“ “ healthy, 102. 

“ “ mercenary, 99. 

“ “ neat, 102, 105. 

“ “ successful, 99. 

“ ’ “ sunny, 105-106. 

“ some qualifications of, 8, 99. 
Nursing, 45, 46, 52, 54, 57. 71, 98, 105-106. 


I 12 


BACTERIOLOGY IN A NUTSHELL 


o. 

Obermeier, 14, 61. 

Oxalic acid, 86. 

Oxygen, 23-24. 

p 

Parkes’ list, 34-35. 

Pasteur, 13, 14, 30. 

Pastry, 104. 

Perforation, 43. 

Peritonitis, 43. 

Peru, balsam of, 89. 

Pfeiffer, 16. 

Phagocytes, 29. 

Plant life, 23-24. 

Plenciz, 10. 

Pneumonia, 15, 60. 

Poisons, 22, 37. 

Pollender, 12. 

Potassium permanganate, 86. 
Protoplasm, 31. 

R. 

Rest, 104. 

Roseola, 52. 

S. 

Sanarelli, 16. 

Sarcinae, 28. 

Schulze, 11. 

Semmelvveis, 12, 

Sepsis, 69, 71. 

Smallpox, 16, 63. 

Solutions, 83-89. 

Spirilla, 28. 

Spores, 30-32. 

Staphylococci, 28, 68. 
Sterilization, 73-78. 

“ Intermittant, 75. 
Sternberg, 15. 

Streptococci, 28, 55, 69. 
Sublamine, 84. 

Sulphur, 90. 

Surgery, bacteria in. 68. 

“ antiseptic, 14. 

“ aseptic, 75. 

Sunshine, 47, 51, 57, 79, 80, 105. 
Sweets, 104. 

Syphilis, 16. 

1T 3 










BACTERIOLOGY IN A NUTSHELL. 

T. 

Table for solutions, 92. 

Teeth, the, 103. 

Tetanus, 53. 

“ preventive measures, 54. 

Tetrads, 28. 

Thiersch’s solution, 88. 

Toy pistols, 53. 

Tuberculosis, 56. 

predispositon to, 56. 

“ nursing in, 57. 

U. 

Uniform, 101. 

V. 

Vaccination, 39, 65. 

Varro, 9. 

Vegetable life, 23-24. 

Vegetables, 45, 104. 

Ventilation, 47, 51, 104. 

Vidal, (note) 49. 

W. 

Water, 45, 50, 89, 103, 104. 

“ distilled, 89. 

“ filtered, 89. 

“ sterile, 89. 

Weigert, 29. 

Whooping cough, 51. 

“Widal’s Test,” 48. 

Y. 


Yersin, 16. 











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